Common Sense

Leadership in a Time of Crisis

Issue: September/October 2020

Author: Lisa A. Moreno, MD MS MSCR FAAEM FIFEM – President, AAEM

 

One of the many wonderful opportunities I have had in the past couple of years has been acceptance into the prestigious Chair’s Development Program (CDP) sponsored by the Association of Academic Chairs in Emergency Medicine in collaboration with the Society for Academic Emergency Medicine. At our most recent virtual meeting, Dr. Susan Stern, one of the course leaders, spoke on Leadership during Times of Crisis. I learned a lot, but I also realized that the Academy and our members are providing exemplary leadership during the current COVID pandemic and this time of political crisis. Here is some of what I learned:

  1. Be present and visible. Leaders need to be seen and heard. During the early days of the COVID crisis, the Board was called to many ad hoc meetings to deal with issues that our members brought to our attention. Members reported that their employment was terminated or threatened with termination when they brought attention to the fact that they had inadequate PPE. Members did, in fact, have inadequate PPE and were genuinely concerned about their health and safety and that of their families. Members were told that they would be asked to ration resources and to send patients home who they would have admitted prior to the pandemic. They were concerned about possible malpractice litigation in these circumstances. The Board not only read their emails, we called each member who had contacted us. We created position statements, collaborated with other EM organizations to take a stand, wrote to legislators in all 50 states and the federal government, and convened task forces under the able leadership of Drs. Walker, Wood, Walters, Pickens, and Mulligan to organize our ongoing response. We were out there: present and visible.
     
  2. Work alongside your team. The AAEM Board are all board certified working emergency physicians. What you do, we do. The problems you are experiencing, we are experiencing. This is critical to informed leadership. How can your elected representatives represent you if we don’t know what your workday life is like? Everyone in the Academy’s leadership is out there getting their hands dirty and doing the work of emergency medicine. 
     
  3. Listen to all voices. Often, this is the hardest part of leadership. AAEM is strongly opposed to the corporate practice of medicine. We don’t budge on this. But when Academy members are concerned about pay and hours cuts, we do need to listen to the rationale that the corporations have for making these cuts. We found that democratic groups were also dealing with decreased volumes, and university employees were looking at hours cuts. We listened, and we had to accept that decreased revenues would need to be absorbed by the physician group. While physicians understandably don’t want a cut in pay or hours, democratic groups dealt with this by listening to all voices as well, and they reached consensus on how to cope. By listening to all voices, we realized that the principles on which the Academy stands hold true: Emergency docs will own a solution they come to democratically and solutions should not be dictated by administrators.

    Another voice we are listening to is that of the residents and students. There is a lot of anxiety out there this year, as students entering the match will not have the opportunity to do any away rotations in EM. This is of more concern to those students whose medical schools do not have an EM residency, and this is true of every HBCU medical school. AAEM has responded by working with our AAEM/RSA leaders, Dr. Haig Aintablian and Dr. Dany Accillien in collaboration with SAEM RAMS to offer the HOME AWAY FROM HOME webinar program for these students to meet and be mentored by program directors from around the country. Our Academic Affairs Committee leaders, Drs. Josh Joseph and Leslie Bilello, will be front and center on this program, along with Drs. Mark Reiter, Mike Dalley, Marianne Haughey, Tiffany Murano, Edgar Ordonez, and many others. 
     
  4. Don’t offer a solution before you hear the thoughts of the team. Dr. Stern pointed out that one group of individuals may not know the issues facing another group of individuals. She found this to be true when planning for the influx of COVID-19 patients led her to consult with not just doctors and nurses, but environmental service workers, hospital police and radiology technicians. The Academy does not endorse any specific sexual orientation or gender identity. Our mission statement supports unencumbered access of all patients to emergency care. We were approached by members of the trans-health community immediately following the recent reversal of a federal health regulation. They informed us that there was concern over trans people being denied access to COVID testing in testing centers run by religious organizations. We listened. Patients worried that they are COVID infected and unable to get a test end up in our EDs or if they are undiagnosed positives, end up infecting others who we will later care for. We listened. We recognized the potential problems because we work alongside our team. We became present and visible, and we accepted the criticism that being visible often begets because no patient should be denied healthcare because of race, ethnicity, gender, gender identity, insurance status, citizenship, disability, or any human condition. 
     
  5. Be generous with information. When people don’t know what’s going on, they will fill the gap with speculation. It is human to wonder what is going on, to speculate on what is likely and to develop a credible explanation when information is not forthcoming. The Academy provided updates on our website whenever information became available. We updated it sometimes daily during the height of the pandemic. We provide a resources page. We make phone calls to every member who emails us or calls the office. Our Legal Committee member Dr. Mitchell Li developed a tracking form to keep us on target with responses to every member expressing employment related concerns. Dr. Fliescher-Black’s Palliative Care Interest Group paired with Dr. Giwa’s new Ethics Committee to work out ways to provide information to community doctors who may not have access to Palliative Care consults and need to have difficult conversations. Through our partnership with the American College of Medical Toxicology, we continue to offer a weekly webinar with top level CDC, OSHA, and FDA scientists and practicing physicians from around the country and the world on the status of vaccine development, critical care best practices, the safest ways to re-use PPE, and how infection is developing and being combated in various cities. 
     
  6. Have a plan. We do. The Academy has a mission statement that is totally transparent and unambiguous. We support the right of every patient to unencumbered care by a specialist in emergency medicine. We support the individual emergency physician’s right to a fair workplace environment and the right to make the medical decisions she has been trained to make without corporate interference. We support residency training and continued medical education. We support the development of our specialty throughout the globe as a medical specialty and not a corporate enterprise. 

It seems quite clear that the Academy is a GREAT leader in this time of crisis. Part of this is down to our sound and ethical mission. Part of this is down to our members, every one of whom is a leader in our specialty, whether in his own shop or in our numerous committees, interest groups, chapters and sections. Shakespeare said of Hermia in A Midsummer Night’s Dream, “though she be but little, she is fierce.” This is so true of the Academy. While we may not be the largest EM organization in the nation, our power comes from the integrity of our mission and our members.