Can you tell me a little bit about what you did before you came to Denver for residency?

Sure.  Before I came to Denver, I was in medical school at Case Western Reserve.  It was while I was there that I learned that there was a specialty called emergency medicine.  Also, I learned that the people in my medical school knew little about it, and I was encouraged to match in internal medicine, which I did.  I spent three years in the internal medicine program at Dartmouth.   While I was there, I met my first emergency medicine mentor, Norm Yanofsky, the chair of emergency medicine, and we became fast friends.  I also came to appreciate that the leading figure in emergency medicine was Peter Rosen, so it became obvious where I wanted to go for my emergency medicine training.  When I finished at Dartmouth I moved to Denver.

Was there a match?  How did you go about applying to the program in Denver?

There was a match.  There was actually a specialty match—that was different than the regular match—for the programs that began as PGY-2 entry.  Because I was a resident at the time, I had to beg, borrow, steal and stretch the truth a little bit to get time off from my residency program to go interview.  When the match came out, I was fortunate to gain acceptance into a position at Denver.

Do you remember that moment pretty clearly?

I do, because that was back before everything was computerized.  It was all done by snail mail.  The letter was lost in the postal system of upper New England-- things must move kind of slow there.  Several days after the deadline, I had still not received my letter.  I was seeing patients in my internal medicine clinic, and the woman who ran the clinic was a good friend of mine. She encouraged me to pick up the phone and call the match people.  I hemmed and hawed, and didn’t really want to do it. Ultimately, I called and found out where I matched.  Another week later, about two weeks after I was supposed to get it, I actually got the letter.  So yes, I remember it very well.

You mentioned being interested in emergency medicine in medical school. How did you first get interested?

Going through all the different rotations, I very much had a clinical bent–I liked seeing patients.  In my medical school, you started seeing patients your first year, so I gained a lot of clinical experience and loved it.  Going through all the third-year rotations, they were all pretty neat. But what I liked the best was when you were in the emergency department in the wee hours of the night—seeing people, taking them to the OR, taking them up to L&D and delivering, or doing procedures—it all started in the emergency department. That was the most exciting part of my rotations.

It was not a “eureka moment.”  Somebody who was a faculty member at the time said, “You should think about emergency medicine as a specialty.”  And I said, “about what as a specialty?” I didn’t even know it existed, and no one else at the school did either.  I was just very fortunate that this person mentioned something in passing.

At this point in your career, has it met your expectations?

Oh, yeah!  Are you kidding?  Especially after this last year!

So, what has the last year [as ACEP President] been like for you?

It’s been pretty amazing.  I travelled almost every week for the last year and a half, all over the country, meeting with old friends and making new ones.  I’ve seen people on their home turf; met with everyone from senators and members of congress, to the heads of the Joint Commission, the Institute of Medicine, and the American Hospital Association; and even got to hear the president in person.

Is there anything that has surprised you about this year?

The big surprise has been, to this day, that while the majority supports emergency medicine, there is still lack of support in some spheres of the house of medicine.  That has been the biggest surprise to me, and that’s been the biggest source of frustration for me.

That sounds difficult. Can you talk a little bit more about how you got involved in ACEP initially?

When I left Denver, I went to a hospital where I was the only residency-trained emergency physician.  The only way I could see people who were trained like me was to go to an ACEP meeting.  I wouldn’t even have realized that, except that there was a gentleman in the city who was about to become president of Ohio ACEP, and he literally came over to my house and dragged me to Columbus to go to a meeting!  After that, ACEP became my outlet whenever I needed my emergency medicine fix.

So, how has your involvement with ACEP progressed over the years?

Again, it was quite unintended. It was never my ambition to become president. We were trained in Denver by Peter [Rosen] and Vince [Markovchick] to be leaders in emergency medicine.  I came back to Case Western Reserve and started the emergency medicine curriculum at the medical school.  As we obtained our residency program, I served as associate director, and then residency director.  All the time, I was dabbling in ACEP, serving on a state committee, then a state board of directors, then state president, then the national committee, then national committee chair.  When I was a national committee chair, I switched jobs to one that had no administrative responsibilities. At that point my wife encouraged me to run for the ACEP Board. The rest is history.

How have you been involved in other EM organizations?

I was a charter member of SAEM and many time annual meeting presenter, an ABEM examiner for more that 10 years, and a CORD member for more than 15 years.

Doing all this traveling, how do you stay in touch with your family and stay sane?

It’s pretty hard.  There’s a balance between my clinical job of seeing patients, my ACEP job of running a $20 million operation, and being a father to a teenage daughter and husband to a lovely wife.  You try to balance them.  This is my ACEP week, and next week is my family week, and the next week is my work week.  You just try to do the best you can.  So far, my family hasn’t left me, I haven’t been fired from my clinical job, and ACEP still likes me, so we’re OK! [laughs]

You just mentioned about Denver trying to create leaders in emergency medicine. What memories do you have of your time in Denver?

They’re really good.  Living in Denver was a lot of fun.  In the two days between residency programs and traveling from Dartmouth to Denver, my wife and I got married, and I was out there as a newlywed.  The people in Denver were really nice.  It was fun knowing we were on the cutting edge of emergency medicine with Vince and Peter, and Steve [Cantrill] and John Marx, and everybody.  So that was great.  And Gene Moore, and all the trauma people were very supportive.  It was hard, because that was back before the work hour rules, and it was a lot of work.  In my case, I did a three year residency in two years, so some of the easier rotations just didn’t show up on my schedule because I had already completed an IM residency!

It was pretty hard but it was also pretty amazing. I just tell people about some of the things that I did.  When I go to a meeting with our trauma group, everybody knows Gene Moore.  When I did my tox rotation, we went up to Barry Rumack’s cottage up in Dillon and hunted mushrooms.

I remember an issue from my first job.  I was taking care of a sick kid, and the pediatricians came down and said, “You can’t take care of this kid, you’re not a pediatrician.”  It quickly became evident that their knowledge of pediatric emergency medicine extended little beyond reading the book - Roger Barkin’s book.  When they found out I trained under him, the issue was resolved!

And are there any particular patient care moments that stick out from residency?

Well, there was one night—it was either Juneteenth or Cinco de Mayo—where I was doing over 5 simultaneous peritoneal lavages.  Then on Christmas morning one year, there were the patients at 5 a.m. who were shooting at each other because they didn’t like their Christmas presents.

One other, on our prehospital rotation, we went out to the airport.  I went out to the control tower, and I sat in the front seat of a DC10 – that was such a blast!

Some of the alumni have talked about a “DG way.” How would you describe that?

The DG way is Vince [Markovchick] and Peter [Rosen]’s way.  It was a very aggressive approach to Emergency Medicine.  We did what we needed to do to take care of our patients.  And if somebody was not doing their job as a consultant, or if the lab was not doing their job, we would just make sure that the patient got what they needed.  If there was a procedure that needed to be done, we did it. It was just a very aggressive approach to being an advocate for your patient.  WE took ultimate responsibility.  There was nothing you didn’t do to help your patient.

And how do you feel like that affects how you practice now?

I’ve had the opportunity to work with people who were less aggressive, if you would, and I’ve seen people who have accepted the status quo, or who have agreed to compromises.  In my particular cases, I don’t compromise on what I know is right. [laughs]

And what was nice, with the Denver way, we were basically at the top of the Emergency Medicine game.  And now, others respect my approach and care, and the medical staff where I work are less likely to engage in patient care arguments.  So it was invaluable to have trained out in Denver.

It’s very interesting to me, I worked a shift at another hospital last night.  There was a situation where someone was not being aggressive, and I just felt profoundly uncomfortable.  And I think that experience does mark us.

You mention Vince [Markovchick] and Peter [Rosen]—how would you describe them as mentors, or other mentors you had?

Vince and Peter were wonderful mentors.  I mean, they had been everywhere, done everything.  It was just a privilege to have worked with them.  Subsequent to graduating, they have both been very generous with their time and efforts and, you know, given me opportunities that I would not otherwise have had: helping me to eventually become a residency director, department chair, and ACEP president. .  .  My time there couldn’t have been better.  It was the best training possible, and it was completely invaluable to my career, and made me a much better doctor, and I’m very grateful for it.

Finally, as you counsel residents now, and think back on what you’ve learned, what advice would you offer to residents as they go through training and beyond?

Well, I counsel people that they have to go and train somewhere where the training they get will fit their personality and needs.  My personality was that of an old athlete, I was aggressive, and believed, “Go for the best and become a leader in the specialty.”  I clearly was fortunate enough to go to the right program for that.

And you mentioned the work hour restrictions now.  Does that concern you for the next generation of Emergency Physicians?

It doesn’t in terms of Emergency Medicine rotations.  We restricted ours to 60 hours per week, which I think is really plenty for an EM resident.  The off-service rotations, I think have to be treated a little bit differently.  Overall though, I do worry that trainees currently with the hour restrictions, do not have enough opportunity to see those things that happen rarely.  Some things happen once in a residency, happen really by random, and the only way you can plan for them in your education is to be there enough hours.  Whether or not this means longer training is needed, I don’t know.

And do you anticipate a lot of resistance to a move to all residencies being 4-year programs?

Oh yeah.  This discussion has gone on and off in the EM literature for 15 to 20 years that I know of.  And the proponents to 3-year programs use the argument that there’s never been a proven difference in outcomes between 3- and 4-year programs.  Which is true, but, I suspect that may change now that we have the work-hour rules.

With the difficulties identified with the EM workforce trying to staff all U.S. Emergency Departments with a residency-trained Emergency Physician, do you think that will make it more difficult to push a 4-year model?

No.  About a month ago, we held a summit in Dallas at the ACEP headquarters.  Every Emergency Medicine organization joined us there.  And it’s very clear that we’re not going to have residency-trained, board-certified, Emergency Physicians in every ED in the country, any time soon.  The workforce shortage we’re facing in Emergency Medicine really is no different than in pretty much every other specialty that exists.  So the bottom line is, globally society is going to have to do something about training more people. We need more medical students, we need more residencies, or, you know, we need to change our expectations.  I do not believe the 3 years versus 4 year issue of EM is going to be the limitation here.  There may be places where we don’t have residency-trained, board-certified people, and that’s just accepted.  If you live in the middle of Alaska, you accept the fact that you’re six hours away from the nearest neurosurgeon.

Well, those are all the questions I have for you.  I really appreciate you taking the time to talk to me.

Sure, always a pleasure—any time.