Fall 2018 Newsletter
In this Issue
- President's Message
- New York and Physician Suicide
- Bringing the ED to the Fairway: Medical Care at the U.S. Open
- I Can't Get No SATISFACTION
Hello, NY Chapter Division AAEM Members!
Welcome to our first newsletter!
I am pleased to be the Chapter President and work with the board of directors to advocate for the values of NYAAEM. I want to take this time to update you on our activities this year.
In March, we surveyed NYAAEM members to gather information regarding the demographics of our membership and determine the direction for this year’s activities. The resources that respondents were most interested in include health policy/legislation as it relates to emergency medicine and addressing satisfaction in the work environment.
Medical Merit Badges
In May, the New York Department of Health (NY DOH) issued “DHDTC DAL 18-09: Clarification Regarding the Training Requirements of Physicians Working in the Emergency Department.” While the NY DOH does not require board certified emergency physicians who work in emergency departments to hold ATLS and ACLS certification, the NY DOH requires PALS certification. David Farcy, MD FAAEM FCCM, and I responded that there is no rational justification to require medical merit badges for board certified emergency physicians who maintain their board certification. Further, merit badges devalue the board certification process by setting a lower bar than a board certified emergency physicians’ education, training, and ongoing learning. (Please see letter printed below). The NY DOH has not responded. ACEP has also contacted the NY DOH regarding this issue, and the Coalition Against Medical Merit Badges (COMMB) is trying to schedule a call with the NY DOH to discuss this.
Social Event at AAEM18
On a lighter note, NYAAEM joined with others for the AAEM Social at AAEM’s Scientific Assembly in San Diego in April. It was a great night of fun and networking with the added bonus of watching the sunset on the San Diego Bay.
NYAAEM Logo Debut
As you are aware, AAEM has a new logo and new website which was launched at AAEM’s Scientific Assembly. With this, NYAAEM also has a new logo, and our website make-over is now complete: www.aaem.org/nyaaem.
Montefiore Medical Center Talk
In July, David Farcy, MD FAAEM FCCM, spoke at the Department of Emergency Medicine at Montefiore Medical Center Moses Division regarding advocating for the rights of emergency physicians and patients and Extracorporeal Membrane Oxygenation (ECMO). Both important lectures were informative, useful, and timely.
National Suicide Physician Awareness (NPSA) Day
September 17, 2018 will be the first annual National Suicide Physician Awareness (NPSA) Day. NPSA Day aims to break down the stigma of suicide, increase awareness of physician suicide, and open the conversation to help prevent suicide. NYAAEM, along with CORD and several other organizations, will sponsor this day. In addition, NY AAEM will host a table at the third annual New York State Suicide Prevention Conference in Albany and provide resources for suicide prevention. Please see the article by Loice Swisher, MD FAAEM, in this newsletter for more regarding physician suicide prevention.
Within our chapter division, Eric Lubliner, MD FAAEM, the past president of NYAAEM, will chair the newly established Physician Satisfaction Committee. Please see his letter in this newsletter. We have also established a Resident and Medical Student Committee chaired by Justin Fuehrer, MD and medical student Brandon Wang.
Continued FREE Dues
As an added bonus, our dues for the NYAAEM Chapter Division are currently free and will continue to be free for the next year. We want more energy and involvement. If you have suggestions, have a project in mind, would like to join a committee, or write an article or submit art for our newsletter, please reach out: email@example.com.
Kristen Kent, MD FAAEM
President, New York Chapter Division of AAEM (NYAAEM)
To me, an outsider, New York and physician suicide goes together like cookies and cream or peanut butter and jelly. It seems like in every handful of doctors who die by their own hand, one of them is from the Empire State — most from the Big Apple, New York City.
- Andrea Liu, a 26-year medical student, died by hanging at the end of April 2018.
- Dr. Deelshad Joomun, an interventional nephrology fellow, jumped from a building in mid January 2018
- In December 2017, Dr. Dean Lorich, orthopedic surgeon was found by his 12 year-old daughter in the bathroom with a self-inflicted stab wound with the knife still stuck in the chest.
- Dr. Gabriel Goodwin, a 35-year-old anesthesiologist, died when he jumped from a Montefiore parking garage in July 2017.
- Dr. Henry Bello killed one fellow doctor and injured several health care workers before shooting himself at the Bronx Lebanon Hospital in June 2017.
- Very recently divorced trauma surgeon, Dr. Robert Ashton, leapt to his death from the George Washington Bridge in February 2017.
- In 2014, two internal medicine interns took their own lives by jumping off building.
These are just the few I know, but there are more. A recent Medpage Today article from two recently graduated medical students, indicated that they knew of seven medical trainees in New York City alone who died during their time in med school. The two young physician authors relayed their heartbreak, anger and confusion regarding the profession in which they just started.
Doctors died by suicide at a greater rate than the general population. With the explosion of social media, the news of doctors killing themselves seem to be an increasingly regular feature. However, this is not a new phenomenon. It has been known since the mid-1800’s, that doctor’s died by their own hand more than others. There is something about this job that weighs heavy on the hearts and souls of those who choose to do this work.
Understandably, but for too long, physician suicide has been shrouded in silence. Suicide deaths are uniquely painful. Survivors often are enveloped by guilt, shame and blame. Those close to the physician who dies may not wish for details to be made public because of this stigma — this shame and pain. The fear of what other’s think, a tarnished memory, or that there may be financial devastation with a self-inflicted cause of death.
It is difficult to open a conversation when those closest do not want anything revealed. Too many times, those others who are suffering and hurt feel shut down from exposing their pain. This dilemma has caused some to see conspiracy that further drives a wedge into the dialog. I have seen the devastating pain of those who have been subjected to internet scorn as they were legally bound by privacy issues from saying more.
We need to find a way to talk about physician suicide- for the sake of our colleagues and ourselves. Even if you yourself do not think that you would ever die by your own hand, you never really know when one that works by your side may be having these very thoughts. This happened to our AAEM President, David Farcy, who last year found one of his colleagues who had taken his own life: read the Common Sense article.
Dr. Farcy called for us to “de-stigmatize depression as something that happens to someone else, to have regular discussions about it, learn the signs, educate ourselves and your colleagues. Create plans within our institutions with a ‘safe talk’ environment. Let us break down the barriers and recognize we all at one point in our lives will contemplate suicide, and let’s look out for each other.”
In an effort to change the trajectory of physician suicides, AAEM has united with CORD, ACEP, ACOEP, EMRA, SAEM, RSA and RSA to initiate the first National Physician Suicide Awareness Day. Multiple other organizations including American Association of Suicidology, the American Foundation for Suicide Prevention and even New York’s state AAEM chapter have lent their support. September 17, 2018 will be a day to create awareness about physician suicide, to remember the ones we have lost, to share our stories, and to develop a dialog. I encourage all members to think of ways that each one of us can make a difference.
National Physician Suicide Awareness Day
Shine a Light. Speak its name.
September 17, 2018
"What has been, need not forever continue to be so.
It is too late for some of our children, but if their plight can make people
realize how unnecessary much of the tragedy is, their lives, thwarted as they are,
will not have been meaningless."
Pearl S. Buck writing about her daughter, Carol, devastated by PKU before the disease was known
Loice A. Swisher, MD FAAEM
Mercy Philadelphia Hospital
Clinical Associate Professor
Drexel University College of Medicine
A year ago, when I was first asked to serve as the medical director for the United States Golf Association’s 2018 U.S. Open Championship, I was apprehensive. I had volunteered twelve years prior, for the 2004 U.S. Open Championship, and remembered the trouble with surprise inspections, absent staff, and missing supplies. Indeed, it required a great deal of work. However, after surviving a year of meetings, spreadsheets, emails, and the actual event, I can say that I thoroughly enjoyed the experience.
Although I had the title “medical director," it took some time to to define the responsibilities of that role. Was I going to order office and medical supplies? Was I going to design the medical record? What were the Department of Health requirements? Who would pay for all the supplies needed? Luckily, the Stony Brook Emergency Medical Services had been involved in many previous public events and was an invaluable resource. Finding volunteers was also a challenge. We started early and sent out plenty of reminders to get staff signed up. We were lucky to get some extra volunteers as we expectedly had some drop out at the last minute. We had to staff three tents with a physician and two nurses or PAs. In addition EMS had multiple ambulances, cart crew and bike crews patrolling the course. I was warned that supplies required by the New York Department of Health would be inadequate and often archaic for the actual needs of the event; I needed to “buff up” our armaments. Knowing this, knowing the resources, and knowing what types of patients we would see at the event, I needed to decide on level of care we could provide. Would we be suturing in the field? Would a volunteer pediatrician know when to give nitroglycerin? Would an orthopedist be comfortable flushing sunscreen out of someone’s eyes? After several considerations and revisions, I was comfortable that we had all bases covered in a realistic manner. We could treat the spectrum of potential emergencies: cardiac arrest, airway support, anaphylaxis, asthma attacks, diabetic emergencies, drug overdose, heat exhaustion, and dehydration.
Then we turned to the more benign interventions: Ibuprofen and acetaminophen for back aches and headaches, a private area for breastfeeding, bandaids for blisters, tampons, and sunscreen. One of the things that helped the most for everyone was our sunscreen dispensers, as so many fans had their sunscreen bottles taken by security. Unfortunately, one problem can lead to another, many people seem to be very bad at applying sunscreen to their faces and needed to see us anyway to wash the sunscreen from their eyes.
In the end, luck and the weather were on our side. And, with the energetic, knowledgeable volunteer medical staff the event was a success. Unfortunately that could not be said of Tiger and some of the other big hitters who missed the cut and departed the tournament early.
Michael Ameres, MD FAAEM
Clinical Assistant Professor of Emergency Medicine
Southampton Stony Brook Hospital
I was recently asked by Kristen Kent, the new president of NYAAEM, to write a short letter about the Physician Satisfaction Committee, and, by extension, physician satisfaction in general.
The purpose of this committee, as I see it, would be to promote the personal and professional wellbeing of ED physicians in our state. Although there is no single definition of satisfaction in this context, we can define it to mean a sense of professional accomplishment in our jobs, unencumbered by the obstructions that stand in the way of our duties to our patients. A sense of personal satisfaction would naturally flow from this. Another way to look at it would be to define satisfaction as the opposite of dissatisfaction and burnout. Burnout levels for ED doctors are at alarming levels: Medscape's Physician Lifestyle Survey for 2017 reported a burnout level for EM physicians of 59%, up from 55% in 2016. The response to this epidemic of physician unhappiness has been all too predictable, with so-called experts reminding doctors to spend more time with family, and to do more yoga and mindfulness meditation. It has taken time for physicians to respond by pointing out that we are not suffering from a lack of access to yoga classes, but rather that we have too little time for ourselves, and, even when we do take time for life affirming activities, we return the next day to the same toxic environment that is causing the problem in the first place.
The specific issues that stand in the way of job satisfaction are many, but they can be summed up as lack of autonomy. In NY State a great many of us do not work in democratic contracting groups; rather, we work as employed physicians or Independent Contractors for CMGs (contract management groups). A recent informal poll that I conducted with the Facebook group ED Docs revealed that only about 24% of respondents work in democratic groups. Among the problems we face: inadequate staffing levels of nurses and ancillary staff, poor scheduling dynamics leading to inadequate time to recover from night shifts, and inadequate time off, excessive demands of charting, unpaid committee and administrative work, excessive burden of (again unpaid) employer mandated education, poor support from ED and Hospital leadership, implementation of QI protocols in the ED without prior consultation of ED doctors, leading to overzealous oversight and further documentation burdens, poor response from specialty consultants, etc. Each of us deals with the above problems, as well as others not listed. The question is, what can we do?
AAEM is an organization committed to the defense of the specialty of EM. Each state chapter seeks to help its members, and all EM physicians in its state, to the best of its abilities. I propose that we meet to set standards for: effective ED functioning and maximal physician satisfaction, nurse and ancillary staff levels as a function of volume and acuity, scheduling standards, consultant standards, due process standards, standards for implementation of QI that involves the ED physicians, etc. After establishing these standards we can publish them on our website.
Eric Lubliner, MD FAAEM
Locum Tenens New York