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emergency medicine

How a Journal Club Article About Mustaches Sparked a Discussion About Diversity in Emergency Medicine

Posted on Wed, Apr 05, 2017
How a Journal Club Article About Mustaches Sparked a Discussion About Diversity in Emergency Medicine

By N. Adam Brown, MD, MBA, FACEP
A few months ago one of my docs had an idea: Let’s resurrect journal club. To some, the idea of hosting a “journal club” made little sense for a community, non-academic practice. In fact, some of our team, especially our physician assistants and nurse practitioners, had no idea what a journal club was. Others who remembered journal clubs of yore thought it could be a great opportunity to discuss up-to-date topics and have the opportunity to socialize with our colleagues in an off-campus, relaxed atmosphere.
Initially, I was skeptical. I remembered journal clubs from residency and never really liked them. For one, journal “clubs” were a misnomer, as they were never really club-like (By the end of residency, I could have had a PhD in clubbing and I knew journal clubs were very, very different). And two, the articles seemed so academic, esoteric and boring to a sleep-deprived, barely-holding-on-to-sanity resident. But now after being out of residency for 10 years and amassing a significant dose of maturity, I began to see the value in hosting such an event. So I decided: Let’s do it.
To my surprise, our first journal “club” attracted quite a number of participants. After socializing, we took our seats to go over the assigned articles. I picked five articles; three were medical articles and two were non-medicine articles on mustaches and implicit bias (And before you wonder if I made a typo, yes, I picked an article about mustaches. I have a mustache so I was drawn to the title). I wanted our journal clubs to be a little different, where we discussed not only up-to-date medical practice, but discussed “hot topics,” issues surrounding physician wellness, and diversity and inclusion.
After discussing the three medicine articles, we started in on men’s facial hair. The article, released in 2015 by researchers at the University of Pennsylvania, hypothesized that men with mustaches were in more leadership positions in academic medicine than women. As I began to present the mustache article, many of my team appeared annoyed and others shook their heads in frustration as I explained the study’s conclusions that men hold 87 percent of academic leadership positions. Further, despite the relatively rare facial hair fashion statement, more mustached men hold leadership positions (19 percent) than women (13 percent). Overall, academic medicine institutions had a “mustache index” of 0.72 (13/19).
After presenting the article and discussing some of the initial points, I asked an open-ended question: Why do you believe fewer women are in leadership positions than men? All the women in the room began looking around at each other as if they were all in on some sort of inside joke that I had missed out on. So I asked again. Then there was a collective sigh. Some of the responses of my mostly female group were as I expected. A few discussed the challenges women have with juggling leadership and home duties. Administrative positions simply did not take priority when compared to caring for their children. Others were more pointed, conveying great frustration with misogyny in medicine going back all the way to medical school and residency.
“Men have more drive and ego,” one of my colleagues said. To which I countered, “Is that true? Do men really have more of an ego than women or did we as a society condition women and men to believe that it’s more acceptable for men to have a more assertive tone and more drive than women?” Some agreed. Society was partially to blame. Another said, “Dr. XYZ (one of our notorious inpatient attendings) always refers to me as ‘girl’ and is condescending to me on the phone.” Another, speaking about a previous practice experience, expressed the real anxiety she felt being the only female in an all-male practice. She went to work every day believing that she had to exceed the expectations and outperform male colleagues to be considered credible and equal. Now, being in a much more inclusive practice, she feels more at home.
What surprised me the most, however, was one of the final comments: “I’m just glad you were willing to talk about this. It says a lot.” (Everyone nodded in agreement.) Think about that for a minute. One of my staff members was just happy that I, a white male with a beard and mustache, acknowledged the gender issues (sexism and misogyny) and gender disparities in medicine. That acknowledgement, she believed, made her feel comfortable to speak to me about advancement opportunities or any other issue. For me, this comment was a “light bulb” moment and a huge win. Could simply talking about these issues open the door to other women or under-represented groups seeking leadership opportunities? Could broaching the subject matter of gender inequality promote greater inclusion in our practice? Quite possibly.
As a regional medical director for EmCare and Chief of EM at my two-ED campus, I am positioned to make real impacts on diversity and inclusion both in the people I hire and in the atmosphere of inclusion I promote. I’m proud to say that after two years as the leader of our practice, we are more diverse than ever (60 percent of our providers are female and 67 percent are non-white). Two of my medical directors are female and both advanced practice leaders are female. Furthermore, our practice truly reflects the community we serve—a community where more than 87 languages are spoken in the public school.
When I first took the leadership position at our hospital, I had one goal: Become the premier emergency medicine practice in the region, delivering the highest quality healthcare. While the idea is simple enough, executing on such a lofty goal is quite difficult. One area where I knew we needed to continue to improve was on practice diversity. Study after study indicates practice diversity not only benefits our patients, but also our employees and our business. With that in mind, I realized expanding diversity is not just a “nice-to-have;” it’s a necessity.
To ensure a healthy, happy workforce and practice, leaders must begin acknowledging the underrepresentation of women and minorities in our field. We must ensure we support an atmosphere of inclusivity and openness. So where do we being? Maybe hosting a journal club where we talk about and acknowledge the “mustache index” is a simple way to get the conversation started.

Dr. N. Adam Brown
N. Adam Brown, MD, MBA, FACEP, is a board-certified practicing emergency physician and the system chief of emergency medicine at Sentara Northern Virginia and Sentara Lake Ridge emergency departments in Northern Virginia. He also serves as regional medical director for EmCare’s North Division, where he leads a team of EM providers, six medical directors, and an administrative support staff for hospitals in New Jersey, Virginia and North Carolina.


14 Envision EDs Recognized for Short Wait Times

Posted on Wed, Feb 15, 2017
14 Envision EDs Recognized for Short Wait Times

The national average for “door to diagnosis” in the emergency department is 22 minutes, but 14 of Envision Healthcare-staffed emergency departments beat that time by at least 18 minutes.

Becker’s Hospital Review’s annual list of hospitals with the lowest emergency department wait times included 59 facilities that reported wait times of four minutes or less, according to the “door to diagnostic evaluation” measure in CMS’ Hospital Compare's Emergency Department Care Measures dataset. Envision facilities made up 24 percent of the list.

Congratulations to the emergency medicine teams at the following Envision client hospitals:

  • Baylor Orthopedic and Spine Hospital at Arlington (Texas) — 3 minutes
  • Belton (Mo.) Regional Medical Center — 4 minutes
  • Coliseum Northside Hospital (Macon, Ga.) — 4 minutes
  • Denton (Texas) Regional Medical Center — 4 minutes
  • Fawcett Memorial Hospital (Port Charlotte, Fla.) — 3 minutes
  • JFK Medical Center (Atlantis, Fla.) — 3 minutes
  • Lafayette Regional Health Center (Lexington, Mo.) — 4 minutes
  • Lee's Summit (Mo.) Medical Center — 4 minutes
  • Medical Center of McKinney (Texas) — 4 minutes
  • Overland Park (Kan.) Regional Medical Center — 4 minutes
  • Poinciana Medical Center (Kissimmee, Fla.) — 3 minutes
  • Research Medical Center (Kansas City, Mo.) — 3 minutes
  • St. Lucie Medical Center (Port Saint Lucie, Fla.) — 4 minutes
  • TriStar Horizon Medical Center (Dickson, Tenn.) — 4 minutes

Wait times data was collected from April 2015 through March 2016. Hospitals with sample sizes of less than 100 and those with results based on a shorter period than required were excluded from the list.


Featured Clinician: Ije Akunyili, MD, MPA, FACEP

Posted on Mon, Feb 06, 2017

The heart and soul of our practice are our clinicians. Meet Ije Akunyili, MD, MPA, FACEP, associate medical director at St Mary’s Hospital in Waterbury, Conn.

Years with EmCare: 1 year.

Years practicing medicine: 7 years.
Dr. Ije Akunyili
Why did you decide to become a doctor? Why did you choose your specialty? Medicine is a second career for me. I started off working in economic policy and development for the World Bank. I became a doctor because I felt like I couldn't change the trajectory of world poverty but I could help one patient at a time. I walked into the emergency department my first week in medical school and never looked back.

What career did you want to pursue when you were younger?  I wanted to be President or a Nobel Laureate.

Describe one of your greatest professional accomplishments. My greatest professional accomplishments in medicine have been leading high-functioning teams to transform emergency departments and provide world-class care.

What is in the pockets of your lab coat? My iPhone. It has every medical app you can imagine. I even have an entire copy of Netter’s Anatomy on my phone. 

What would be your ideal category on “Jeopardy”? Before and After.

How do you stay organized at work? I am constantly “running my mental list” – who needs disposition, who is in imminent danger or deterioration, who needs more attention. By placing patients in well-defined lists, I am highly efficient. 

What are your tips for “leaving work at work” and not getting burned out professionally? Schedule your life outside of work the same way you would your life at work. Make your family and hobbies a priority. Allow yourself one unscheduled day every 3 months.

How are you Making Healthcare Work Better®? I continue to push the envelope for excellence in emergency care. I strive to reduce disparities in healthcare and practice evidence-based and cost-efficient medicine.
What’s the best advice you’ve received about work or life? The best advice I ever got about life was from my mum, who always reminded me to always work three times as hard, and that the world would never be fair.
What do you enjoy outside of work? I am an avid reader, and like every working parent, I spend time with my kids at home and sporting events. I also love to travel and strength train.

What’s your favorite inspirational quote? "Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure" by Mariannne Williamson.

What qualities make a successful doctor? I am not only passionate about the science of the human body and disease processes but also about taking care of patients. I love the variety of the human existence I see everyday in the ED.

How would your co-workers describe you? Driven, passionate, intense, hardworking, emotionally connected with patients. Gets things done.

Tell us something that most people at work don't know about you. I once competed in an amateur bodybuilding competition. I didn't win, but it was so much grit, fun and determination.

If you could have dinner with anyone, living or historical, who would you choose and why? My mum, who died two years ago. I would give up everything in the world to have one last dinner with her.  
What’s the most interesting place that you’ve been? Cape Town, South Africa. I lived in South Africa as an undergraduate around the fall of apartheid. I fell in love with Cape Town, the landscape, the melancholy beauty that defies words.

What are you currently reading? I'm reading Bryan Stevenson’s “Just Mercy.” It's a memoir from one of the leading public defenders in our country chronicling the grave human cry for mercy that is our criminal justice system. I'm also concurrently reading a book on ED flow and lean theory.

What’s your favorite TV show? I watch exactly 1 hour of TV every week. No more, no less. And that one hour has to be the show Scandal! When its off season I don’t watch any TV. 

What personal accomplishment are you most proud of? I am most proud of my two beautiful children. They are my lasting legacy to the world.


How to Choose the Right Clinical Job Opportunity

Posted on Mon, Oct 31, 2016
How to Choose the Right Clinical Job Opportunity

It’s hard to believe that we are already two months into the 2017 residency recruitment season.

Over the next several months, residents across the country will interview at multiple places until they find the ideal opportunity. Residents will receive advice from current and former colleagues, their residency directors and others. So for what it's worth, I’m going to offer you my advice.

First, enjoy the moment. Reflect on what you are about to accomplish. Ten-plus years of learning, training, dedication and sacrifice is finally leading to the start of your emergency medicine career.

Choosing the right opportunity brings a mixture of excitement and stress, so I encourage you to develop a career plan. The first step is to ask yourself what’s truly important to you today. Long term, the number one criteria for landing an ideal opportunity is location. In the short term, you may want to travel, practice in a variety of settings, pursue a leadership track or find a location that will assist in paying down your student loans. Once you answer this question, you can plan accordingly.

Several years ago, I recruited an EM physician. His first name was Dan, and for a five years, worked on average 1,800 hours per year. During his residency, Dan was a chief resident. He was brilliant physician. The nursing staff liked working with him and his patient satisfaction scores were always high. Our leadership team easily formed the opinion that he would make an outstanding medical director in the future. When Dan interviewed with us, he expressed that his long-term goal was to become a medical director or chief medical officer. At the end of Dan's second year, he was offered an associate medical directorship. He turned me down. When I asked him why he stated, "It is not part of my plan today." His plan was to pay off all of his student loans within the first five years after he completed residency. Once Dan paid off his loans, within one year, he accepted a leadership position.

The second step of finding the right opportunity occurs during the interview process. During the interview, you must evaluate who you will work with. This starts with evaluating the medical director during and after the interview. Finding a medical director who will mentor, guide, teach and inspire you will create an environment that will encourage you to stay long term or prepare you for the next opportunity. This is not always easy to determine, but you can assess the medical director by asking questions to the other physicians, nursing staff or other members of the hospital leadership team. The second part is evaluating the physicians and advanced practice providers that you will work with. The medical director and nursing staff will help you to determine if these are the types of colleagues you want to work with.

The third step is determining if the location has what you are looking for, from housing, schools and shopping to recreational activities, religious activities and other considerations. This may conflict with your first plan out of residency, but the location will be the primary factor for choosing an opportunity for your long-term plan.

The last piece of free advice is when you find the right opportunity, one month before you start work, and before you start making 4 to 6 times what you were making as a resident, hire a financial advisor to help you develop a plan. You'll sleep better at night knowing your financial future is in good hands.

Jim McMillin

Jim McMillin is the National Director of Provider Recruitment for EmCare.


On the Road with Ray: Dr. Iannaccone Visits Palms West Hospital

Posted on Mon, Sep 12, 2016
On the Road with Ray: Dr. Iannaccone Visits Palms West Hospital

Earlier this year, EmCare’s Executive Team launched a “road trip” initiative to better connect with providers in the field, recognize teams that are “making healthcare work better,” and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.

Located in the greater West Palm Beach area amid gated communities and polo grounds, Palms West Hospital is a vibrant, growing facility that serves patients across the economic scale.

Because the hospital is near bustling coastal resorts and a stone’s throw from working farms, EmCare’s emergency department teams at the site – one focused on adult patients and second dedicated pediatric team in an adjacent unit – see everything from equestrian falls to migrant worker injuries to a spike in the winter when northerners descend on the area for a reprieve from colder temperatures.

Despite being in a beautiful and balmy location, John Halpern, DO, chairman of the Emergency Department, admits that recruiting quality physicians has been a struggle, as there are competing hospitals vying for the same candidates. This challenge is one of the reasons why Dr. Halpern asked EmCare’s President, Ray Iannaccone, MD, FACEP, FACHE, to visit his site.

“I think it’s important that the company’s executives hear from the ground troops – the men and women providing care in our EDs,” explained Dr. Halpern. “It’s a new step for EmCare, and I wanted our team to be able to get more engaged with the company.”

But this meeting wasn’t the first time that Dr. Halpern had met EmCare’s president; When Dr. Iannaccone was an emergency medicine intern in the U.S. Navy, Dr. Halpern was his attending physician at Portsmouth Naval Medical Center. It’s a small world, indeed.

The visit provided an opportunity for the company’s administration to better understand the culture at Palms West and brainstorm ways to capitalize on the facility’s advantages for clinicians. These discussions included Erika Vazquez-Cuffe, MD, medical director of pediatric emergency medicine; Venkat Kalidindi, MD, executive vice president; Michael Davis, FACHE, division client administrator; Palms West CEO Eric Goldman, and several Palms West emergency physicians and advanced practice providers.

While Dr. Vazquez-Cuffe has only been at the helm of the pediatric ED since November 2015, she and her team have been able to make significant progress in improving key clinical metrics.

“Palms West is in a great area and it has strong relationships with local emergency medicine residency programs, which is a plus,” Dr. Iannaccone said. “Its pediatric services are a real differentiator in the market, and I’m proud of how EmCare has been able to partner with the hospital to grow that offering.”

The hospital, which sees about 140 ED visits a day, chiefly serves young families and affluent adults. It doesn’t see a high percentage of seniors in the off-season, but during the winter, the senior population in the area can spike significantly.
A key topic of discussion was the facility’s sepsis initiatives and how the team plans to meet national guidelines. And, like most EDs, Palms West relies on referrals to grow its volume, so EMS outreach also was discussed.

“We sat down and had a heart-to-heart talk about the challenges and opportunities that we have here,” Dr. Halpern said. “Several clinicians had specific questions for Ray, and he committed to looking into their concerns. It was a positive meeting and I’m glad that I reached out to him.”

After touring the facility and speaking with the hospital’s administrators, Dr. Iannaccone and several clinicians had a dinner meeting at a local restaurant to continue their discussions.

“They have a good team at Palms West, and we’re going to work together to find ways to recruit more residency and fellowship-trained physicians and continue to improve outcomes,” Dr. Iannaccone explained. “Our clinicians now know that the Executive Team cares and that we’re listening, and we’re here to help.”

“It was great to meet Dr. Iannaccone,” Dr. Vazquez-Cuffe. “We feel privileged that he has taken time from his busy schedule to show us his support. We feel confident that he supports the growth and betterment of our staff.”

Visit EmCare's Facebook page for more photos from Palms West! And, if you would like to suggest your site for a future visit, please contact

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