Agraphia Medical Tragicomedy


Sea Change

So, I'm leaving the private practice world.

It feels good to say.  No, it feels GREAT to say.  I'm going back to academic medicine... massive pay cut, terrified medical students, new residents, the whole 9.  I can't wait.

This year has been transformative for me. Working out in a private ER is so different from academic medicine they might as well be two ends of the same beast. I'll really miss this place.  The nursing staff is fantastic.  The money, equally so.  My colleagues, uniformly, have been incredible to work with - supportive, intelligent, no-nonsense.

The problem is, I've never been able to internalize the feeling that I've "arrived."  Private practice in many ways is the culmination of everything.  K-12, college, medical school, residency... it has been school for 24 years if you count it all up.  Then suddenly you graduate from residency and they tell you you've made it.  You're ready to do things on your own.  No supervision!  You're an adult!  You know everything!

But I know that's not true.  I've always been inquisitive.  I still listen to ER podcasts to and from work, two hours a day.  I learn new things every single shift.  I suppose that's why they call it practicing medicine.  And I want to be on the forefront of medicine; learning, teaching, researching.

I've taken a lot of things away from this year.  I have immense respect for anyone who practices community emergency medicine.  It's honestly one of the hardest jobs I can imagine.  No matter how fast you are, you can always be faster.  No matter how thorough you are, you can always be more thorough.   There are twin pressures at play in the ER - see patients quickly enough to not let someone die in the waiting room, but spend enough time with each patient so you don't miss something life threatening.  It's exhausting, unbelievably stressful, and difficult.

I've also had more free time this year than I've ever had before.  I work 12 shifts per month.  Initially I was bored.  Then I found a passion for cooking and the gym, dropped 35 pounds, and now I'm in better shape than I was in high school.  I'll take this forward with me through my career - being healthy is important to me, and I was too busy in medical school and residency to learn how to do it right.

Perhaps most germaine to the rest of my carer, I've learned about my own personal practice style.  I'm a big believer in patient-centric care.  I ask people if they think something is broken before I x-ray it.  If they say no, that they just want to know what to do for the sprain, I'll forgo the x-ray.   A lot of physicians are over-testers, in large part thanks to malpractice liability.  It's a shame, really.  Many of the best physicians I've known are impeccable clinicians not because they overtest, but because they carefully listen to patients and take the time to properly examine them.

And so, friends, it is with great excitement that I announce... I'll be leaving the south for the midwest in July.  Goodbye, pork BBQ.  Hello, beef BBQ!

Dr. Zac, Academic ER MD

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  1. i hope this doesn’t mean an end to your blogging…i really enjoy your blog and would hate to see this be the end of it!

  2. Bravo! Onward.

  3. Good luck on your move. I’m a recent reader of your blog and I’m wondering if you’d be able to share a list of the podcasts you mention.

    • First and foremost is EM:RAP. It’s a monthly 3-4 hour long podcast that is very thorough and is CME credit-worthy. Really an incredible listen. I also listen to EMCrit by Scott Weingart and Keeping Up by the guys out at Vanderbilt (although I think this last one is currently defunct).

      There are like… 12 years worth of EM:RAP so going through the backlog will keep you set for quite a long time.

      • Yeah, as a big fan of edu-blogging and podcasts, EM:RAP is by far the best. And it’s usually fairly funny as well, which helps cut through all the dry facts and numbers. Plus, it’s the most listened to, so odds are at someone you work with listens to it as well, which makes for good conversation during long shits as you debate back and forth things heard on the blog.

        Zac – I’ve been following your career moves for a while now, and find the whole thing interesting. I don’t know if you were cheif in your program, but I’m guessing you probably were. Did you find that this opened any addiontional door? Even now a year out of residency? Did it help you get back into academics after being out in the community? Even if you weren’t not chief, was their any greif about moving from one sector to the other given to you by either side of it ?

        • Actually, I wasn’t chief. Not for lack of trying, but every single one of our residents applied for the position, so the field was pretty tight. I think that being chief resident can be quite helpful, but it’s not necessary. If you’re interested, go for it!

          As far as moving back and forth from academics to private, I think there are a lot of emergency physicians now who are doing short stints in private practice and then going back to academics. It’s pretty well accepted that practicing in the high-pressure environment of the community is quite helpful to make you a better doc.

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