Good point Apollyon, and maybe I'M reading this wrong. My apologies to Birdstrike, and I infer no sarcasm with that statement.
Being a medical director is a thankless job, and really takes a different outlook to accomplish well - I'm still working on it!. Taking care of patients is a multi-system process within the department. It requires a common desire from everyone - Doctors, Nurses, Techs, and Secretaries to work in a well-run department. This is the viewpoint that ED attending physicians see every day and anything outside of this scope is "someone else's job to fix." The good attendings are able to remain happy and keep the department on task, while finding creative ways around roadblocks that slow the flow of the department - they manage the department well.
I haven't been doing this long, but I've come to realize that my day is not impacted by the number of patients I see, but by how difficult the patients are to move out of my department. Note - I didn't even mention how difficult they are to manage and treat. Perhaps it was a selfish decision to pursue a directorship, but I believe our field is all about how to take the most chaotic heap of dead, dying, and helpless situations, control them, and then get them where they need to be. This isn't meant to imply that our patients are any of these things, but the work around them is. Anyone who has cared for 10 critical patients in a shift, with a full ICU, no beds, frustrated nurses, and a busy waiting room can compare that day to a day of seeing 30 patients with clear-cut dispositions.
This is why I found becoming a director to be a really cool thing. Hospitals are essentially a venn diagram (remember those?). Each department has a series of protocols and bylaws and rules that overlaps with each other one. The neat thing about the ED is that all of the major players in a hospital have a single place where they all overlap - The Emergency Department. Whether they want to talk about it as such or not, the ED is the only place in the hospital where fast and accurate identification and treatment of disease is made. Most of the time, its where the diagnosis is made. When we admit patients to services, our workup and diagnosis starts the path of the patient's stay - our job is the most understated, but overused in medicine.
As the delivery of our healthcare system continues to evolve into whatever it is, one thing is certain - more and more patients are going to continue to use the ED as a front door, and hospitals are starting to listen. What other parts of the hospital register patients, treat them, and either keep them or send them home? The OR does, dialysis does, Radiology does, but when things go wrong, where do they send their patients? to the ED. When the internist sees a patient in their office, where do they send them for chest pain workup? The ED.
Our departments have evolved into hospitals within hospitals, and we are more reliable to our community and its physicians than any other part of the hospital. This is what drives me, and makes we want to improve things. I consider the ED to be a second chance at healthcare in the United States. When patients call their doctor, the doctor doesn't say "go to the hospital." They say "go to the ER." As a director, I'll have the ability to effect change on the entire hospital by working with the other departments to create policies, protocols, and guidelines that help us use the department more effectively and more efficiently. In the end, that makes all of our jobs easier, and when we don't "feel" busy, we don't act busy. When we don't act busy, our patients love us, and when our patients love us, everybody does, especially the hospital looking over us - which doesn't make us "feel" busy anymore. Then they cycle repeats itself.
Of course, this is a continuous work in progress, and there is always something new to change or reject. I enjoy solving problems on a systems basis, and try to view the department as my patient of sorts (cheesy, I know). There are many departments with their own agendas, revenue stream, political capital, etc, but I really do believe that over the next few years, and well into the next decade, the ED will become the single largest revenue generator for hospitals. This means the ED will have the most political capital in the coming years. I may be wrong, but I am proactive to make sure that as the department becomes more of a resource to the hospitals, the way it is run becomes more efficient and more important.
Patients come to us for many reasons. As this thread already implies - most of them don't want to be there, some of them do, but none of them want to wait. Interestingly, neither do most of the staff that works in the ED. We actually have a common goal with our patients - to make things move as smoothly and efficiently, to give (and receive) the best and safest care, and to get on with our lives and wellness. The hospitals are catching on to this, and to me, its pretty exciting to be a part of.
Of course there are many other aspects of the job that I really like too, but for the students/residents, this is the biggest reason that I decided to become a director. I may be crazy, but only time will tell...
