In My Opinion
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History’s great achievers—Napoleon, da Vinci, Mozart—have always managed themselves. That, in large measure, is what made them great, according to Peter F. Drucker, father of modern management theory. This principle is especially relevant to emergency medicine today. The founders of our specialty and the wave of emergency physicians that followed them have carved us a unique position in the house of medicine. We have reached a stage where managing our specialty and its next steps carefully are critical to great achievement.

It is hard to imagine that less than 35 years ago we did not have primary board status with the American Board of Medical Specialties. At that time, other specialties questioned whether emergency physicians offered truly unique skills. They suggested that our skill set was merely a partial collection of those of several different specialties. However, the skills to intubate a patient in respiratory failure, resuscitate a neonate, diagnose and treat a heart attack, and deliver a baby do not by themselves an emergency physician make. It is the ability to lead a team successfully through simultaneous medical, surgical, psychiatric, and social emergencies while managing the clinical and administrative activities of the ED as a whole. In other words, leadership and management define the core of the specialty of emergency medicine.

We are clinicians. What separates us from other specialties is that we are also managers. We need not redefine ourselves. We need only to embrace that which we already are. We have embraced our clinical prowess – gaining primary board status, growing in numbers, establishing strong research credentials, and becoming a popular specialty. Let us also embrace the core that ties our clinical work together. Let us embrace management – its theory, practice, and application to emergency medicine. Doing so will unleash the full potential of our
specialty.

In what seems to be an uncanny coincidence, not only are emergency physicians natural leaders and managers, but we are also afforded a view of health care that equips us to wield our core expertise beyond the emergency department. Each day at work, we take 10 hour-long swigs from the fire hydrant of the U.S. health and social system, MacGyver-ing our way through a shift to fashion the best possible result for each patient. Is there anything in patient care we don’t see? Is there any perspective we don’t understand? This torrent of information that we receive from our patients about their health, illnesses, and troubles with the health system is invaluable knowledge that needs to be put to use. We must develop a system to harness this knowledge.

Namely, we must formally recognize and develop leadership and management as the core of our specialty. Currently, emergency medicine residents undergo pseudo-management training by virtue of working in the ED – on-the-job management training. Thus, most emergency physicians today are at least adequate managers. But as a specialty, we must raise the bar from adequacy to specialization by focusing the provision of emergent care through the lens of formal training.

Management is a widely researched topic that is studied and applied in every sector. This repository of theoretical and practical knowledge belongs in every emergency medicine curriculum. Every emergency medicine resident today is training to become a clinician and a manager. In most cases, the former is acknowledged and developed while the latter is largely ignored, despite a wealth of available resources.

Secondly, a wider range of educational options should be made available to enable emergency physicians to develop innovative health care solutions. Some programs already offer combined EM-Master’s degree opportunities. These opportunities must be promoted heavily. We should develop more EM-MBA programs to promote leadership in the corporate sector and EM-MPA/MPP programs (Masters in Public Administration/Masters in Public Policy) to promote political leadership. As management takes root and unleashes our specialty, the demand for such programs will increase. We should develop professional relationships and management experiences with local business schools and industries that demand the highest standards of management to ensure success.

Emergency medicine must follow its natural tendencies and reach out beyond the health sector to glean the best from the best and bring it home to the bedside.

Today, the political and corporate worlds are converging at the health sector. This movement was reflected in the 2010 Adelaide Statement on Health in All Policies, a World Health Organization (WHO) publication.

To advance Health in All Policies the health sector must learn to work in partnership with other sectors. Jointly exploring policy innovation, novel mechanisms and instruments, as well as better regulatory frameworks will be imperative. This requires a health sector that is outward oriented, open to others, and equipped with the necessary knowledge, skills and mandate. This also means improving coordination and supporting champions within the health sector itself.3

Taken together, the steps of formally developing leadership and management as the core of our specialty and promoting new educational options encouraging emergency medicine leadership will uniquely qualify us to be the champions that WHO describes. It will undoubtedly fortify the position of emergency medicine as a powerhouse, cutting edge specialty and attract highly motivated, superior talent to our ranks. These steps are not only important, they are also necessary to accelerate the momentum our specialty has developed over the past several decades. Fully matured, emergency medicine will be a specialty representing highly trained, trans-sectoral, transformative clinician-leaders who provide superior clinical care in the emergency department and are dedicated to a healthy society through the advancement of health care on all fronts. By working toward this goal, the modern emergency physician stays true to the spirit of service in which emergency medicine was founded and guides the trajectory of our specialty toward health sector leadership.


References
1. “Managing Oneself.” Drucker, Peter F. Harvard Business Review. v. 83, no. 1 (Jan. 2005), pp. 100-109
2. “Anyone, Anything, Anytime: A History of Emergency Medicine.” Zink, Brian J. 2006
3. Adelaide Statement on Health in All Policies. World Health Organization, 2010. http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf


5 Management Resources for EPs

1. ACEP Director’s Academy
A multiphase course at ACEP HQ (Dallas, TX) with excellent faculty teaching management skills and the business of delivering care.

2. The Studer Group
Whether you’re reading Quint Studer’s books (Hardwiring Excellence is a favorite), attending their ED-specific course, or having a Studer coach come to your department for an assessment, there is a fit for your needs.

3. The Center for Medical Education
Courses taught by excellent faculty tackle a broad range of the most current problems that medical directors face.

4. ACEP Scientific Assembly
The college’s annual meeting brings together numerous administrative lectures aimed at improving the skill set of emergency physician administrators.

5. EPM’s ‘Directors Corner’
With  over a 100 articles available online, EPM’s administrative column tackles most quandaries an ED medical director might face

 

Comments   

# Dean, College of Osteopathic Medicine, Des Moines UniversityJD Polk, DO 2013-08-22 14:43
Dr. Kumar

I agree with you. Emergency Medicine physicians do make good managers and clinical leaders. But I would take it one step further. We as physicians gave up control of medicine in the 1970's when managed care hit town. Still to this day, a hospital CEO with an MBA can take the Board of Governors exam from the American College of Healthcare Executives and become "board certified" in medical management. Although the American College of Physician Executives also has something similar in the form of the Certified Physician Executive curriculum, neither the ABME nor the AOA has embraced making a board specialty out of management. Yet informatics, quality, business, clinical practice guidelines, insurance, and now the Accountable Care Act clearly necessitate that we begin manufacturing more physician leaders.
Perhaps it is time we started to take back our destiny and make a formal recognized board by both the ABMS and AOA in medical management with business, academic, quality, and informatics tracks. Then the seasoned physician, with a great deal of clinical experience and some on the job management experience, can get their masters degree in the associated management field of their choice and sit for the "management boards".
I think it is time we start taking back medicine and making our future clinical leaders, and codifying the requirements.

Best

J.D. Polk, DO, MS, MMM, CPE, FACOEP
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# Dealing with brain injury case managementCase management 2013-09-05 22:49
It would really be a painful experience for the individuals if they have to go through severe injuries. case management (http://ncmuk.co.uk/case-management-services/paediatric-case-management/cremation urn) professionals are expected to handle such situations with great care and provide moral support to the patient’s family as well.
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# Anoop Kumar, MD 2013-09-14 09:42
Dr. Polk,

The ABMS and AOA can make management a specialty, but I'm not sure how much that would contribute to improving health and healthcare. It would, however, help us to have more control over healthcare. The kind of disruption that leads to innovation in other industries is less likely to occur in healthcare if we certify ourselves, so to speak. I think having exposure to non-healthcare business thinking and then applying it to the bedside is the way to go. At the same time, I don't think getting another degree signals the readiness to be a manager. Learning to manage multiple complex situations that have real, serious consequences with limited resources is the path to becoming an emergency physician... I mean, manager. That is why emergency medicine is unique. As a specialty, it stands apart from all others as primarily a management specialty. It is uniquely positioned in this healthcare environment to be a major force if we take the right steps in the next few years. I hope this is recognized by the influential people in our specialty.

Sincerely,
Anoop
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