The Pulse- Winter 2020 by ACOEP

WINTER 2020

DOCTOR RX PRESCRIPTION FOR CAREER PROGRESS

BECOMING A CHIEF MEDICAL OFFICER: HOW DOS CAN RISE UP IN EXECUTIVE LEADERSHIP PG 9

BREAKING THROUGH THE BOYS CLUB: FINDING YOUR PATH AS A WOMAN IN EM PG 13

APRIL 14-17, 2020 THE WESTIN KIERLAND RESORT & SPA SCOTTSDALE, AZ FEATURING KEYNOTE SPEAKERS

SCOTT WEINGART, MD

CHRIS HICKS, MD

LEARN MORE: ACOEP.ORG/SPRING

ARLENE CHUNG, MD

The Pulse VOLUME XLIII No. 1

EDITORIAL STAFF Timothy Cheslock, DO, FACOEP, Editor Wayne Jones, DO, FACOEP-D, Assistant Editor Tanner Gronowski, DO, Associate Editor Justin Grill, DO, FACOEP John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Erin Sernoffsky, Director of Media Services Gabi Crowley, Senior Communications Manager EDITORIAL COMMITTEE Timothy Cheslock, DO, FACOEP, Chair Justin Grill, DO, FACOEP Christine Giesa, DO, FACOEP-D

The Pulse is a copyrighted quarterly publication distributed at no cost by ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors, and liaison associations recognized by the national offices of ACOEP. The Pulse and ACOEP accept no responsibility for the statements made by authors, contributors, and/ or advertisers in this publication; nor do they accept responsibility for consequences or response to an advertisement. All articles and artwork remain the property of The Pulse and will not be returned. Display and print advertisements are accepted by the publication through ACOEP, 142 East Ontario Street, Chicago, IL 60611, (312) 587-3709, or electronically at marketing@acoep.org. Please contact ACOEP for the specific rates, due dates, and print specifications. Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisement due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2020 – All rights reserved. Articles may not be reproduced without the expressed, written approval of ACOEP and the author. ACOEP is a registered trademark of the American College of Osteopathic Emergency Physicians.

TABLE OF CONTENTS 3

PRESIDENT’S REPORT Robert E. Suter, DO, MHA, FACOEP-D

THE EDITOR'S DESK Tim Cheslock, DO, FACOEP

THE ON-DECK CIRCLE G. Joseph Beirne, DO, FACOEP-D

ROBERT SUTER, DO, MHA, FACOEP-D, SWORN IN AS THE NEW PRESIDENT OF THE AMERICAN COLLEGE OF OSTEOPATHIC EMERGENCY PHYSICIANS Erin Sernoffsky

BECOMING A CHIEF MEDICAL OFFICER: HOW DOS CAN RISE UP IN EXECUTIVE LEADERSHIP Ashley Altus

BREAKING THROUGH THE BOYS CLUB: FINDING YOUR PATH AS A WOMAN IN EM Angie Carrick, DO, FACOEP, and Stephanie Davis, DO, FACOEP

GET READY FOR AN ED-VENTURE!

BY POPULAR DEMAND, ACOEP’S REVAMPED WRITTEN BOARD PREP RETURNS TO CHICAGO Gabi Crowley

JANICE WACHTLER, BAE, RETIRES AS ACOEP PREPARES FOR THE FUTURE

MARK YOUR CALENDAR!

ACOEP’S COMMITTEE FOR WOMEN IN EMERGENCY MEDICINE UPDATE Teagan Lukacs, DO, MPH, MBS

BOARD CONSULT

WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE Bernard Heilicser, DO, MS, FACEP, FACOEP-D

PRESIDENT’S REPORT

Robert E. Suter, DO, MHA, FACOEP-D

THE WAY FORWARD TOGETHER

am deeply humbled and honored to have the privilege to serve as your president for the next two years during this time of great opportunity for our College and our community of emergency physicians. Thank you to you, my professional family, for your trust; and thank you to my wife Michele, my children, and my grandchildren for the sacrifice they are making to allow me to serve our College. As many of you know, about six months after becoming presidentelect I was unexpectedly promoted to brigadier general in the Army Reserve. So, while I am still practicing emergency medicine, the Army is once again my major commitment outside of ACOEP. Being in the roles of ACOEP President and General have some interesting parallels. Both positions allow me to provide leadership to professionals who have dedicated their lives to protecting the health and well-being of others, albeit in different ways. Both soldiers and the physicians in our community are united by shared values. Both groups have volunteered to serve others. I have tremendous respect for you and am very proud to serve together in our important roles to advance our patients and our values. We have endured many changes in the osteopathic profession over the past several years to which we, as a College, have had to react. At

the end of our Scientific Assembly, the Board convened in strategic planning to chart our way forward with the objectives of efficiency, participation, and leveraging our strengths in our collaborative relationships at front of mind. While still in the draft phase, I can share that we determined key areas that will need significant focus – realigning College operations and finances, expanding membership participation, adding value to membership, and leveraging our relationships with other organizations to promote our agenda and members. While we value the intimacy of our ACOEP family, we are stronger when we can find a shared vision with those who ultimately share the same goals. We may have differences on some issues, but focusing on our shared goals will create more productive relationships and opportunities for you, our members. In concert with multiple other organizations, we will fight for you on issues of importance to all emergency physicians. At the same time, we will continue to

IF YOUR ACTIONS INSPIRE OTHERS TO DREAM MORE, LEARN MORE, DO MORE AND BECOME MORE, YOU ARE A LEADER.” – JOHN QUINCY ADAMS develop projects and resources that emphasize both our uniqueness and our willingness to be inclusive of all emergency physicians who choose to be a part of our community. This work must continue – not only to ensure current and future generations of osteopathic physicians choose our specialty but to make sure our hospitals can continue to provide emergency care for our patients, especially in rural and other underserved communities. We will continue to do this work on your behalf with your help. As a result of the Single Pathway and other changes, we are in a brave new world of emergency medicine. A world without boundaries, full of limitless potential for our younger members. One that, sometimes, may feel too big. Our College can be a special place of refuge and comfort, a place that is big enough for us but not so big that we feel that we are suffocated by the crowd. A CONTIN U ED ON PAGE 12

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THE EDITOR’S DESK

Tim Cheslock, DO, FACOEP

DEVELOPING YOUR BRAND

s a new attending physician, there is a lot of excitement and anticipation of finally being out on your own. You are now the captain of the ship, leading the team with numerous chances to show that you have what it takes to be an emergency physician. When you enter the practice, there will be many other opportunities as well. How you choose to develop the rest of your career and what direction it takes is now all up to you, and you need a helping hand. ACOEP has incredible resources for New Physicians in Practice (NPIP), those who are within the first ten years of practice. As a product of the NPIP and the many opportunities it has afforded me, I’d like to share some of the exciting things you can do as part of

this young motivated group. Up until now, your life has been planned out. Your schedule, rotations, time-off, exam dates, and academic obligations have all been clear over the last three to four years. You were settled in one location, your check came every two weeks, and life was on autopilot. Now you can control many of your variables as you are in this new phase of your career. You might be asking yourself questions like: • What type of job setting do I want? • Will I work as an employed physician or an independent contractor? • How will I get my benefits and what benefits should I be looking for? • How do I want to develop my career?

ACOEP’s NPIP provides a great resource and sounding board for many of these questions because they are all in the same situation. They have all been through similar challenges that you may now or soon be faced with. The NPIP Committee of our college has grown over the last seven years. We have been able to offer dedicated lectures and activities about financial management, career development, and career advice. We encourage each other and meet often for social activities as well. Get involved with ACOEP and our NPIP and I guarantee it will be a rewarding experience and one that will allow you to reach your full potential, wherever your career takes you! –•–

• Take care of yourself and your family first.

NPIP’S FAVORITE ADVICE FOR NEW PHYSICIANS

• Make sure you prioritize disability insurance, life insurance, health care insurance, and having an emergency fund. • Contribute to your retirement accounts from day one and maximize the potential of those offerings. • Decide how you want to contribute to the specialty and seek a mentor or friend to help you develop in that track whether it be academics, leadership or lecturing or just being a stellar EM physician.

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THE ON-DECK CIRCLE

G. Joseph Beirne, DO, FACOEP-D

SUSTAINING A LIFE-LONG CAREER IN THE ED

y the time you read this, 2020 will be well underway.. I hope the holiday season filled all of you with the happiness of family and friends and a renewed spirit. As your new president-elect, the “On Deck Circle” will be my quarterly column to provide updates on ACOEP and emergency medicine. Erin Sernoffsky, who has been with ACOEP for 11 years, tasked me with the topic of career advice – on the experiences I’ve had both inside and outside of the ED. I thought about this for a long time. Over the last 19 years, I have seen a countless number of patients and learned many lessons. I recall seeing an article titled, Now that You’re a Real Doctor by James Roberts, MD, who writes a monthly column in Emergency Medicine News. The article dealt with the transition from resident to attending and how to find your way in the

BE THE ADVOCATE FOR YOUR PATIENT. THEY NEED YOU!” – JAMES ROBERTS, MD

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world of emergency medicine. One of the points he made in that article that still resonates most with me today is, “Be the advocate for your patient. They need you!” Over my career, this thought has always been with me as I cared for each patient. It seems such simple advice, yet we often lose sight of this in the ED. We want to make the diagnosis, provide a disposition, and try to continue managing our flow of patients. In the extraordinarily busy world of our departments, this thought may seem a herculean task at times. I was struck by this recently when a patient I saw in my department, who I have taken care of many times, told me, “You know why I keep coming here? Because you always treat me like you would your mother. It just shows in your nature. I feel like I’m part of the family.” After hearing this, it validated not only my reasons for choosing medicine as a career but why I chose osteopathic medicine. Even though the emergency department is acute care, some of the patients we see are “frequent flyers.” They do indeed become a part of who we are and what we accomplish daily. After that shift was over and I was driving home, I thought to myself, “If someone asked me why I chose emergency medicine, what would I say?” Here’s my answer:

DON’T LOSE SIGHT OF LEARNING POSSIBILITIES When you are a new attending physician, the possibilities seem endless. You have a “real” paycheck, and you now get to make your own decisions. The real world is a scary place when you are a new attending. You will order more tests than you need, you will admit more people than you should. Every physician has been in this position. Your learning curve will improve each day of your career. In five years, you will be more confident. In 10 years, you will feel like a pro, and in 20 years, you will feel that there is no case you cannot handle. The physician who tells you they have nothing left to learn is a fool. When I was a new attending, I valued the experienced physicians in my group as mentors. I bounced cases off them when I needed to, I talked to them about how to improve my work, and how to best succeed. As an experienced physician (now PGY 20-something, as my friend Dr. Siberski loves to say) the new physicians in my group seek my help and advice, and I seek theirs. They are my colleagues, my teammates, and my family.

FAMILY COMES FIRST My wife and I have one daughter, who is now a college senior. She was three when I graduated from residency. Watching her grow up and

sharing those experiences with her has been one of the most satisfying experiences of my life, and one that I would never want to miss. Your family is your support system and will always be there for you. Be there for them! Don’t be afraid to come home and talk about what happened at work. Share the good and bad times with them. They will likely never realize the enormous burden you carry dealing with the acute and chronically ill patients on a day-to-day basis, but they will always listen and comfort you, as you do for your patients. Don’t miss those milestones in your family’s lives. They only come once, and you will never get those moments back. Your “second” family is the ED staff. They are an important part of your life as well. We typically spend 40 or more hours each week working 10 and 12-hour shifts with them. They will share their happiness, their grief, their successes, and failures with you, as you will with them. Take care of your second family as well! Treat your ED staff with respect and kindness. Your nurses, paramedics, technicians, and unit secretaries are what truly make an ED successful. They will make you a better physician.

BE MONEY SMART Financial savvy is something all of us lack at some point. One of the most important conversations I had as a new attending was with a senior partner in our group who told me, “Don’t live beyond your means.” Once you see that first paycheck, it’s tempting to start dreaming of things you want. I was fortunate to find a good financial advisor early in

my career. He files my taxes each year, reviews my investments with me frequently, and has dispensed invaluable advice. Begin your 401K early. Make sure you are vested in your group’s pension fund. Start planning for your children’s education early. The amount of debt they will incur will likely be two or- three times, or more, what we paid for medical school. Missouri, my home state, has a 527 MOST plan that allows you to invest money for your children’s education. One of the gifts my wife and I wanted to give our daughter was to graduate from college (and graduate school, if she chose to pursue higher degrees) debt-free. It is one of the most rewarding gifts you will ever give to your children.

CULTIVATE OTHER INTERESTS One of the unique things about emergency medicine is that it provides us with time away from the job to pursue outside interests. As you progress in your career, you will come to realize that we cannot eat, sleep, and breathe medicine 24/7/365. All of us need time away from a demanding job. On your days off, explore what life has to offer. My family and I love to camp and enjoy the outdoors. I play ice hockey and have been studying Tae Kwon Do for 13 years. On November 23, 2019, I tested and received my 5th-degree black belt. Tae Kwon Do has provided balance to my life and kept me physically, emotionally, and spiritually healthy. I encourage you to follow those interests that make you happy and keep you healthy.

SPEAK UP FOR YOURSELF We advocate for our patients for healthy lifestyles. Advocate for yourself! Your health is just as important as your patients’ health. We often put ourselves on the back burner, so to speak, but it’s important to take care of yourself as well. Get a primary care physician and keep up with your routine health screenings. We cannot care for others if we don’t care for ourselves!

REMEMBER YOUR WHY The last, and the most important, piece of advice from a guy who has been on the front line for almost 20 years: be true to your passion for medicine. Think back to what motivated you to pursue this career, and remember that every day before you see your next patient. Many patients, families, friends, and ED staff have asked me, “How can you come back, day after day, and do this job? Doesn’t it get to you? How do you handle this?” My answer each time is this: making a difference for one patient each day, no matter what it is, is the “juice” that keeps me coming back each day. Whether it is getting a patient a warm blanket, having someone thank me for sitting down and listening, or even just a smile from a patient -- that’s what this job is all about. My passion for medicine many years ago was to make a difference. My passion for medicine today is just as strong, if not stronger. Be the leader in your department and set that example every day. You will go home with a sense of satisfaction and will light the path for others to follow. –•–

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ROBERT SUTER, DO, MHA, FACOEP-D, SWORN IN AS THE NEW PRESIDENT OF THE AMERICAN COLLEGE OF OSTEOPATHIC EMERGENCY PHYSICIANS By Erin Sernoffsky

n a membership ceremony at Scientific Assembly in Austin, Texas, Robert Suter, DO, MHA, FACOEP-D, took the oath of office becoming the 21st President of the American College of Osteopathic Emergency Physicians (ACOEP). “It is an honor and a joy to serve my EM home in this capacity,” said Dr. Suter. “We have an incredible team and an ambitious roadmap for the future. I am excited to get to work on behalf of all of our members and our entire community.”

WE HAVE AN INCREDIBLE TEAM AND AN AMBITIOUS ROADMAP FOR THE FUTURE. I AM EXCITED TO GET TO WORK ON BEHALF OF ALL OF OUR MEMBERS AND OUR ENTIRE COMMUNITY.” Dr. Suter and the ACOEP Board have built an agenda centering on transparency and collaboration. Their work will focus on building strong bridges to partner organizations, engaging ACOEP’s members, and advocating on behalf of all emergency medicine professionals.

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“Dr. Suter has incredible experience and a proven track record of leadership and advocacy,” said Christine Giesa, DO, FACOEP-D, ACOEP’s Immediate Past President. “But what excites me most is the path he is forging for ACOEP. He has incredible plans and is already working hard to engage the Board, members, and staff to make real, lasting progress.” Dr. Suter is a Brigadier General in the United States Army Reserve. In his distinguished military career, he has served in Iraq and Afghanistan with the 1st Cavalry and 3rd Infantry Divisions. He was the Reserve Consultant to the Surgeon General for Emergency Medicine and has commanded the 94th Combat Support Hospital, the 2nd Medical Brigade, and the 3rd Medical CommandForward. In the latter position, he served as the Commander of the medical and healthcare forces in the 13 nation CENTCOM region. In his decades of service, Dr. Suter has worked in every healthcare setting and has demonstrated a strong commitment to advancing osteopathic medicine on a local, state, and national level. He was the first osteopathic physician to serve as an officer on the board of the American College of Emergency Physicians

(ACEP) where he served as president from 2004 to 2005. He also won ACEP’s John G. Wiegenstein Leadership Award, the College’s highest honor. Dr. Suter also served as Vice President of Quality and Health IT for the American Heart Association, and as a Professor in the Department of Emergency Medicine at UT Southwestern in Dallas. In addition to being recognized as an expert clinician, he is also the author of scores of studies, papers, and textbook chapters in emergency medicine, and

has given hundreds of presentations worldwide, especially in the areas of Evidenced-Based Practice, EMS, Practice Management, Quality, and Health Policy. “I am so thankful to all the leaders in ACOEP who have built this incredible foundation, and I am excited to expand on this legacy,” said Dr. Suter. “We are already making progress in creating openness with our members and strong collaboration throughout the medical community. I am thrilled to be part of this important new era of ACOEP.” –•–

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GREAT CARE STEMS FROM TAKING CARE OF YOUR PHYSICIANS AND MAKING SURE IT’S EASY FOR THEM TO NAVIGATE THE SYSTEM, MAKING SURE PROCESSES ARE STREAMLINED AND REMOVING ANY BARRIERS OR INEFFICIENCIES SO THEY’RE NOT BURNING THEMSELVES OUT.” - DR. HAULER

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LEADING THE WAY

BECOMING A CHIEF MEDICAL OFFICER: HOW DOS CAN RISE UP IN EXECUTIVE LEADERSHIP INTERESTED IN BECOMING A CMO? TWO DOS SHARE WHAT YOU NEED TO KNOW. By Ashley Altus

tepping away from clinical medicine to pursue a health care administration role can be a difficult choice for a physician. “I miss clinical medicine, but now I feel fortunate to take care of clinicians as well as patients,” says Jennifer Hauler, DO, vice president and chief medical officer at Premier Health in Dayton, Ohio. As a CMO and physician advisor at Cary Medical Center in Caribou, Maine, Regen Gallagher, DO, oversees care for the hospital’s patients. “I’m still looking at the care of patients every day, even when I’m not personally providing that care,” Dr. Gallagher says. Ensuring efficiency and safety are often the main responsibilities for chief medical officers, but exact duties vary depending on the organization. Some CMOs wear several hats. Dr. Hauler is responsible for three hospitals and five campuses. She also oversees the emergency trauma institute and the hospitalist division and contributes to Premier Health’s strategic planning. In addition to being CMO, Dr. Gallagher serves as her hospital’s compliance officer and risk manager, where she oversees the operations for several departments, including anesthesia, pharmacy, oncology, health information, infection control, quality and case management. In this edited Q+A, Drs. Gallagher and Hauler provide a behind-the-scenes look at life as a CMO and share how DOs who are interested in health care leadership can get started.

WHAT DOES SUCCESS AS A CMO LOOK LIKE FOR YOU?

Dr. Hauler: The stories we love are when we have patients with difficult medical and social needs and we get them through the system efficiently where they are set up for success. Great care stems from taking care of your physicians and making sure it’s easy for them to navigate the system, making sure processes are streamlined and removing any barriers or inefficiencies so they’re not burning themselves out. Dr. Gallagher: There are individual wins, for instance, when you helped a physician accomplish something with a patient or you represented the physician well to the administration. There are bigger wins too, like managing operations for the bottom line responsibly, growing services, and contributing to overall financial vitality. As a rural hospital, we are the largest employer in our town. If something happens to us, something happens to our town.

WHAT ARE SOME OF THE CHALLENGES YOU FACE IN YOUR ROLE?

Dr. Hauler: Finding the right physicians. I know we’re producing more students, yet there are still physician shortages and holes that we just can’t plug and manage. Staffing, in general, is very challenging. Finding great environmental service workers and dieticians is just as important as finding great physicians. Dr. Gallagher: The physicians—there are management classes where they talk about

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herding cats. We now train people in teambased care, but most of the people practicing currently were trained before that. The youngest physicians are trained in a team model, but most of the folks were trained in the authoritative model, where what they say goes. Trying to get physicians to swing that viewpoint around is definitely one of the most challenging aspects.

MEDICAL SCHOOLS AND RESIDENCY PROGRAMS DON’T TRAIN PHYSICIANS IN MANAGEMENT, OPERATIONS OR FINANCES. IS AN MBA NECESSARY FOR PHYSICIANS INTERESTED IN PURSUING AN ADMINISTRATIVE LEADERSHIP ROLE?

Dr. Hauler: I don’t think an MBA is an absolute requirement. The great thing about physicians is that they are leaders by nature. They are either leading a two-person team, themselves and the patient, or a multi-person team, the health care team.

Dr. Gallagher: An MBA is very helpful because it tells other people you know the lingo. It gives you credit right out of the gate. It opens more doors for you, particularly if you’re looking to move outside of your current organization.

WHAT ADVICE WOULD YOU GIVE TO PHYSICIANS INTERESTED IN ADMINISTRATIVE LEADERSHIP?

Dr. Hauler: What I love about the osteopathic profession is that we really are a big family and the role of the mentor is huge. You can always find DOs who are willing to help out and talk about their leadership journey and help you identify where you want to be. Physicians are always asked to serve on committees and working groups, and that’s a great way to dip your toe into the pool. Take the opportunity to take on an area of medicine you’re passionate about. Dr. Gallagher: Just say yes to things. Show interest and people will take you under their wing. Find opportunities in your organization and state medical association committees where you can network and meet people.

WHY IS IT IMPORTANT TO HAVE PHYSICIANS IN LEADERSHIP ROLES?

Dr. Hauler: Health care is all about the patients. Who understands the patient better than the physician? Having a physician’s voice, therefore the patient’s voice, involved in the decision-making makes all the difference in the world because physicians are advocates for their patients. You need someone who has a sense of both sides seated at the table when the stakes are so high. These are lives we’re talking about. Dr. Gallagher: The whole reason a hospital exists is to take care of patients, and that’s all physicians train to do. The patient can get lost easily in the viewpoints of some people who haven’t taken care of patients. It’s important to have people in leadership who have been on the ground providing care to patients to help make decisions, especially when you’re trying to weigh financial priorities. Having people who keep the patient at the center of those decisions is imperative in order to have high-quality care. –•– Originally printed by the AOA in The DO on July 24th, 2019. Visit www.TheDO.osteopathic.org for more information.

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BREAKING THROUGH THE BOYS CLUB

FINDING YOUR PATH AS A WOMAN IN EM By Angie Carrick, DO, FACOEP, and Stephanie Davis, DO, FACOEP

omen in emergency medicine face many hurdles their male counterparts do not. Addressing these issues is central to the mission of the ACOEP Committee for Women in Emergency Medicine, one of ACOEP’s fastest-growing sections, providing clinical lectures, career advice, and networking opportunities.

DOCTOR MOM One of the foremost differences women in EM face compared to male physicians is managing the balance of responsibility between home and work lives. Our male counterparts often more easily release the pressure or guilt of “getting things done” at home. Whether that is regarding children, home maintenance, dishes, or laundry, in general women find themselves pulled in both directions more frequently, particularly when it comes to childcare. Mom guilt is a very true entity and wears on a female physician intensely. This dichotomy is a very real contributor to physician burnout. Maternity leave and breastfeeding are also a major barrier that women in emergency medicine face. Often, hospitals do not provide paid maternity leave, creating significant financial and personal burdens for physicians. When seeking assistance in covering shifts, physicians often feel

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guilt for putting colleagues in harder positions. This can often result in physicians returning to work too soon or leaving the ED altogether. Once returning to work, new mothers not only deal with the expected stress of establishing child care and returning to professional life but logistics such as breastfeeding and pumping also come into play. Federal standards and advocacy for support of working mothers will not only assist physicians who have had a baby but allow the entire ED to function with more clarity and consistency when these issues arise.

THE B WORD Females also face the challenge of owning our role as a physician. Imposter syndrome is especially felt and internalized by female physicians. This can be exacerbated by “the boys’ club” that often permeates the ED. Women are frequently not included in golf trips or beers after a shift. Often, these experiences not only build bonds among coworkers who depend on each other but can have realworld ramifications when it comes to career advancement and support. Women in medicine often face the challenge of the difference between being aggressive versus assertive. It is a fine line that male

colleagues do not face. Sometimes the only difference in the perception of our response is our gender. A male colleague may respond to a situation in a way that’s perceived as authoritative, but if a female physician responds in the same way, it can be seen as aggressive or “bitchy.” This is further exacerbated by patients who mistake female physicians for nurses or more easily defer to male physicians, nurses, or residents. As female physicians, we walk a fine line. If women are too friendly with nursing staff, we risk losing a sense of authority, and if we remain distant, we are seen as noncooperative.

CREATING EQUITY The great news is that in the face of overt and systemic bias, women have incredible tools at their disposal to overcome these obstacles. The first step is removing internal barriers. Feelings of inadequacy often hold women back. Women are more likely to wait to apply for positions of leadership until they can prove they meet every criterion or wait to be asked to run join committees or apply

for leadership positions. We encourage women to move past these invisible obstacles. The simple act of trusting your abilities and putting yourself out there can surprise you. Some ways to get started include: • Running for a board • Volunteering for a committee • Writing an article You have experience and expertise to share. If you run and lose, your name is now more recognizable as someone eager to lead and serve and will find more doors to walk through as a result. Furthermore, finding a mentor is an incredible step. Successful women in EM are everywhere and often are willing to take younger physicians under their wings, showing them the ropes and how to navigate difficult situations. A mentor can make a profound professional impact. It’s important to remember that if you are experiencing a roadblock at work, chances are there are other women experiencing something similar. Seeking out others is an incredibly powerful means to create

success. Groups such as FemInEM, ACOEP’s Committee for Women in Emergency Medicine, and more share resources, tools, education, and create a strong community and pathway for success.

SEND THE ELEVATOR DOWN No matter where you are in your career, you can help those coming up behind you. Attending physicians can take residents under their wings; residents can in turn help students assigned to their EDs. Women are often eager to see other women succeed, and those who have reached the top floor can send the elevator back down for those just starting. By helping to guide doctors coming after you, you can make lasting, substantive change. Women in EM do face more challenges than their male counterparts. However, these roadblocks do not put a definitive end to your aspirations. We also have the benefit of a strong community and can walk on a road paved by the pioneers who have come before us. –•–

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GET READY FOR AN ED-VENTURE! P

ack your bags and prepare for an ED adventure! ACOEP is returning to the Westin Kierland Resort and Spa in beautiful Scottsdale, Arizona for the 2020 Spring Seminar. “I am so excited to share all of the changes, updates, and new innovations in this year’s conference,” said Course Chair Christopher Colbert, DO. “We’re taking what’s worked in the past and making it even better. We’ve got big-name speakers, awesome lectures, and improved competitions. There’s just so much to look forward to!” Three keynote speakers headline the conference: Arlene Chung, Chris Hicks, and Scott Weingart. “Our keynotes are EM famous,” said Dr. Colbert. “Everyone either knows their names or should know their names. They do so much to move our field forward and I’m thrilled they are joining us.” Additional stand out names in the robust faculty include Rob Bryant, Jamie Hope, David Tallon, and Travone Thompson. The keynote speakers are not only providing must-see lectures, but they are also serving as judges for the Case Study Poster Competition. “This year, we’re integrating the competitions further into the conference itself and utilizing our keynote judges to give real-time feedback to participants,” said Dr. Colbert. The Case Study Poster Competition and the New Innovations in Emergency Medicine Competition both provide important avenues to compete, add to a resume, meet with important figures in emergency medicine, and make a name in the field. In 2019 ACOEP unveiled the Ed-Venture Series, which offers attendees a chance

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to customize their learning experience. For 2020, the planning committee improved upon the inaugural success. This year, attendees can choose four topics to take a deep dive into, spread out over two days. Ed-Venture topics include: • Cardiology • Management and Malpractice • Language and Opioids • Stroke and Headache • Literature Review • Pediatric Ultrasound ACOEP’s rapidly growing Women’s Committee is also back with incredible clinical lectures, networking opportunities, and the chance to give back by volunteering as a mentor runner with Girls on the Run during the FOEM 5K. The New Physicians in Practice and RSO are both back in full force in Scottsdale. With evenings out, happy hours, networking events, lectures, and more, Spring Seminar is a must-beat event to help at any level of your career. This is also a great event for your family — the Kierland has activities for every age and interest, ACOEP’s Women’s Committee is working to make child care options easy to access, and ACOEP staff is hard at work making sure attendees head home with fun memories in addition to enhanced clinical skills. “Last year we introduced events like wine tasting, yoga, and movie night, and attendees loved it,” says Interim Executive Director Adam Levy. “We’re excited to bring more of these opportunities to our members this Spring. ACOEP has always been great at balancing working hard with playing hard, and as your EM home we’re excited to raise the bar even higher this year!” –•–

WRITTEN BOARD P R E P BY POPULAR DEMAND, ACOEP’S REVAMPED WRITTEN BOARD PREP RETURNS TO CHICAGO By Gabi Crowley

COEP’s Written Board Prep returns to our hometown of Chicago this winter, February 24th-28th. Led by top-notch faculty, this five-day course offers all the information and resources you need to ace your board exam. “The course is designed to hit all the highyield and moderate-yield topics from the AOBEM table of specificity and ABEM clinical model,” Written Board Prep Course Chair Brian Acunto DO, EJD, FACOEP, said. The revamped course is specifically created with the attendees in mind, breaking down topics into smaller lectures to keep attendees engaged. “It’s designed to have depiction so that the high-yield information is literally at the top of your brain.” From emergency medicine residents to attendings to advanced practice partners, Dr. Acunto is confident that physicians at any level will benefit from the course. “The course is intimate, and attendees have direct interaction with the faculty. This allows the attendees to focus on the subject at hand and take away the key points,” Acunto said. “Anyone looking to get a good review of emergency medicine knowledge base will not be disappointed.” “Finding the time to sit down and go over

essential material to refresh our brains is very hard to come by,” Acunto said. Dr. Acunto understands that medical providers have limited time when it comes to studying and test prep. He currently is the director of Emergency Services for Atlanticare Regional Medical Center’s City Division in Atlantic City l, NJ, has served on ACOEP’s CME Committee for the last three years, and has been the course chair of ACOEP’s Written Board Prep for the last two years. In addition, he recently received his executive juries’ doctorate from Concord Law School, Purdue University Global. “ACOEP’s Written Board Prep allows one to decompress their schedule and sit down and dedicate time to review the essential material emergency medicine providers will need to be successful not only on the boards but in their careers.” When asked about a piece of advice he’d give to anyone attending this year’s course, Dr. Acunto stressed the importance of self-care. “Come for the review and don’t be afraid at the beginning or end of the day to take some time for your own well-being. Whether it’s exploring some of the city’s museums and theaters or enjoying some of the fine restaurants Chicago has to offer, take care of yourself, too!” –•–

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JANICE WACHTLER, BAE, RETIRES AS ACOEP PREPARES FOR THE FUTURE

anuary marks the end of an era for the American College of Osteopathic Emergency Physicians (ACOEP) as longtime Executive Director Janice Wachtler, BAE, officially enters retirement. “For decades, Jan’s name has been synonymous with ACOEP,” said ACOEP President Robert Suter, DO, MHA, FACOEP-D. “It’s safe to say we would not be where we are without her stewardship, and ACOEP will not be the same without her in the driver’s seat.” Jan’s tenure at ACOEP began in 1992 as the sole staff member. Throughout her time with the College, ACOEP experienced exponential growth in membership numbers, educational opportunities, career advancement, and much more. Jan leaves ACOEP as the second-largest specialty college and a leading voice for emergency physicians across the country. Members had the opportunity to honor Jan’s work at special events during ACOEP’s 2019 Scientific Assembly in Austin, Texas. Her legacy and passion for education

continue through the Janice Wachtler Educator of the Year Award, presented this year to Judith Tintinalli, MD. Jan’s transition began this summer as day-to-day operations shifted to Interim Executive Director Adam Levy, who previously served as Director of Events and Strategic Initiatives. “Change is always difficult, and we are profoundly thankful for Adam’s dedication in navigating this one,” said Dr. Suter. “He has done a tremendous job balancing increased responsibilities, implementing new procedures and policies, and keeping ACOEP moving forward. We owe Adam a great debt of gratitude.” The ACOEP Board has established a search committee to conduct interviews to officially name Jan’s replacement. A job description has been made public, and the application period closed on January 2nd. Interviews will be conducted in Chicago and the committee plans to name a permanent replacement in February. –•–

FOR DECADES, JAN’S NAME HAS BEEN SYNONYMOUS WITH ACOEP” - ACOEP PRESIDENT ROBERT SUTER, DO, MHA, FACOEP-D

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MARK YOUR CALENDAR! 2020 is upon us! Be sure to mark your calendars with these important dates, and keep your eyes out for more to come including ACOEP’s Oral Board Review and additional Student Symposiums. –•–

JANUARY 2020

APRIL 2020

January 13th – 17th 2020 Resident In-Service Exam (RISE)

April 14th – 17th ACOEP’s Spring Seminar

FEBRUARY 2020

April 19th – 25th National Osteopathic Medicine Week

February 24th – 28th Written Board Prep February 27th – 28th LEAD 2020

MARCH 2020 March 16th Match Day March 21st ACOEP Student Symposium at Jefferson Health NE March 21st – 27th AOBEM Written (Part I) Exam

JULY 2020 July 27th – August 6th July Assessment Exam

OCTOBER 2020 October 11th – 15th ACOEP’s Scientific Assembly

NOVEMBER 2020 November 9th –10th AOBEM Oral (Part II) Exam

March 21st – 27th OCC Cognitive (Recert) Exam March 30th – 31st DO Day on Capitol Hill

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destination where we can still get the tools to make sure that our patients receive excellent care and where you find joy in your practice. We want ACOEP to be your organization of choice. It may or may not be your only portal to participation in our specialty, but we want it to be your favorite one. The liaison relationships or partnerships we have with nearly every organization in emergency medicine and organized medicine from the national level to the International Federation of Emergency Medicine

will provide you with the support and benefit of the work of all of these organizations. We pledge to you transparency in our College operations, limitless opportunities to participate, and recognition for national-level scholarly and professional activity. We offer opportunities that are only available to you and our community. As many have noted, these are the types of opportunities that can launch careers and be the basis for longterm professional success. Seize them by contacting me or anyone on

our Board to express your interest – we will get you started! In closing, thank you again for your membership and support of our community, our professional family, and our College. I look forward to the next two years working together with all of you to advance our patients, our values, and our members. My goal is to provide you and our College the inspiration and the means to achieve our most ambitious dreams of success. Our best days are ahead of us! –•–

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ACOEP’S COMMITTEE FOR

WOMEN IN EMERGENCY MEDICINE UPDATE By Teagan Lukacs, DO, MPH, MBS

his year, ACOEP’s Scientific Assembly provided a platform for the Women’s Committee to raise awareness and celebrate some great causes

IDENTIFYING VICTIMS OF HUMAN TRAFFICKING We had the privilege to work with PATH, Physicians Against the Trafficking of Humans, to explore the complexities of identifying patients who are victims of human trafficking and how best to help them. The organization provides information on the scope of the problem, tools for screening, intervention strategies, and resources for physicians. Many victims are drawn into the lifestyle around the time of puberty and are not kidnapped but drawn in by empty promises. Screening is critical because we, as physicians, are on the front lines for identifying people who may be in dangerous situations. Remaining compassionate and non-judgmental can go a long way for these patients. A good place to start is by asking if they are lacking basic needs like food and clothes, or starting with simple questions like, “Are you okay?” It’s vital to build trust and ensure their

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confidentiality; for example, you can offer to use an alias in the electronic medical record. While speaking to your patients, it’s important to provide information without pressing them, with the goal of empowering them. The physicians who attended this training session with PATH left feeling empowered. They are now equipped with the skills and materials to train the course at their home institutions and communities. Knowledge is power, and PATH provides links to many state-specific resources as well. Please see their website for more information: www.doc-path.org

EMPOWERED WOMEN EMPOWER WOMEN The Women’s Luncheon was a great success this year with inspiring words from trailblazing women who continue to pave the way for women in emergency medicine. The 2019 recipient of the Willoughby Award is Dr. Dara Kass, the founder of FemInEM, a platform for female emergency physicians that provides professional development opportunities, resources, and other forms of support. FemInEM provides an online and in-person arena for women in medicine to connect, to tell their stories, and to have productive conversations.

They have been able to start rectifying, or at the very least drawing awareness to, common problems such as underrepresentation on panels at national conferences, maternity and paternity leave, wage equality, resilience, mentorship, sponsorship, and professional promotion. Dr. Kass has done amazing work in breaking down unconscious bias, promoting women’s professional development, and achieving gender equity in emergency medicine, making her the perfect recipient of this year’s Willoughby Award. Our other guest of honor, Dr. Judith Tintinalli, has had a robust career promoting emergency medicine as a specialty and advancing womens’ roles in the field. This year, Dr. Tintinalli was awarded the Janice A. Wachtler Educator of the Year Award, given to a physician who has achieved a pinnacle level in education and is considered a consummate role model to the EM community. Dr. Tintinalli has served in

many educational positions, including as editor-in-chief of the world’s largest selling emergency medicine textbook, AccessEmergencyMedicine. com, and Emergency Physicians Monthly. She is the deputy editor of the Annals of Emergency Medicine, professor and chair emeritus of the Department of Emergency Medicine at the University of North Carolina at Chapel Hill, president of the Council of EM Residency Directors, and past president of the Academic Chairs of Emergency Medicine. Equally as important as her leadership and author positions are the lectures and presentations she’s given. Dr. Tintinalli has spoken on topics including the future direction of emergency medicine, international emergency medicine, and women in medicine. Dr. Tintinalli has directly affected the state of our specialty in the US and globally through her educational materials and guidance. She continues to be a leading voice to make medicine, and specifically

emergency medicine, all that it is today. Over 100 people joined the Women’s Luncheon to celebrate with doctors: Kass and Tintinalli, and all the remarkable female pioneers at Scientific Assembly.

ACOEP’S WOMEN’S COMMITTEE SWAG This season ACOEP’s Women’s Committee has launched sales of custom clothing and merchandise. We have also designed pink versions with the Breast Cancer Awareness ribbons and proceeds from this line of merchandise will go to the Breast Cancer Research Foundation. The Foundation has spent over 25 years researching breast cancer preventions and treatments with a recent focus on metastatic breast cancer. Be sure to purchase some ACOEP’s Women’s Committee gear and join us for our educational sessions at the Spring Seminar, April 14-17, 2020, in Scottsdale, Arizona. See you there! –•–

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BOARD CONSULT

our ACOEP Board has amassed an incredible amount of experience. We asked some of them for the best advice they ever received and here’s what we heard. –•–

The best advice I received: don’t choose a job based on the money, but rather the people you will work with – including your boss and their relative respect for the team.”

– JOHN GRANETO

The best advice I got, and this is not what you typically think of in emergency medicine, was to take the time to join hospital committees. I had an attending tell me that it would help keep me up to date (and know how to stay out of trouble – clinically and otherwise), help me understand what items were critically important to the system, and open career doors. He was absolutely correct.”

– JUSTIN GRILL DO, M.ED.HP, MHA

Treat everyone with respect! From the janitor to the CEO, it takes a village, and each person plays a vital role in helping the entire hospital function smoothly.”

– MEGAN KOENIG

The best career advice I have ever received is that your medical career is a marathon, not a sprint. Your career may take unexpected paths but be open to developing your skills and talents in areas that may be unfamiliar to you and know they can be rewarding.”

– JENNIFER AXELBAND

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Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do?

Ethics in Emergency Medicine In this issue of The Pulse we will review the dilemma presented in the Fall 2019 issue regarding the 62-year-old male with a court order to be transported for psychiatric evaluation. Our patient was unable to care for himself and was covered with maggots. EMS loaded the patient and he began wheezing and went into respiratory distress. The on-scene police demanded transport to the hospital ordered by the judge, not the closet hospital. Contact with that hospital resulted in the diversion to a closer hospital because of the patient’s clinical condition. EMS capitulates and transports to the initial court-ordered hospital. Should the EMS crew have disobeyed the police? How would you handle this situation as medical control? This EMS call presented quite a dilemma. Of course, as advocates for our patients, we have that primary obligation: the sanctity of our oath. Considering the police are not medically trained, one would hope they would defer to the medical professionals for the well-being of this patient. But, of course, police officers have their own orders to follow. How do we mitigate this problem? Here’s our suggestion: When EMS calls Medical Control, the ED physician is responsible for this EMS direction and outcome. This individual should get on the radio and ask to speak to the officer in charge of the scene. Explaining the medical necessity, and consequences of non-medical authority making medical decisions, can go a long way in politely “supporting” the police officer to reconsider his demand. Of note, I did get a legal opinion on this and it supported patient advocacy, with the caveat that there could be legal problems in the future. Although every situation in the ED is different, the best way to care for your patients is to advocate for them calmly and work together with different teams to find the best solution for your patients. –•–

If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at esernoffsky@acoep.org. Thank you.

WEDNESDAY, APRIL 15, 2020 5:30 PM - 6:30 PM EARLY BIRD PRICING PRIOR TO 3/20/20 ATTENDING PHYSICIAN: $60 RESIDENTS, STUDENTS, AND FAMILY: $30

FOR MORE INFORMATION AND TO REGISTER, VISIT: WWW.ACOEP.ORG/SPRING

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