Our Workforce: View from a Retiring E.R. Doctor

Philip L Levin, MD, FACEP

I graduated from medical school in 1978 at age 24, debt free (medical school was cheap!) and eager to be a family doctor. I entered Corpus Christi’s three-year family medicine residency and began moonlighting in rural South Texas emergency rooms that same year. I fell in love with emergency medicine on my first shift and vowed to make it my life’s work. Soon after finishing my residency, I took the E.R. boards, grandfathering in.

For the next forty years, until June of 2020, I practiced full time emergency medicine. That month the administrator and the E.R. chief told me I was too old to continue practicing emergency medicine. Perhaps they were right … time to make room for the younger docs. They moved me out to the clinics. It’s a much easier life … no night shifts, slower paced, easier patient issues. But, boy, do I miss the excitement and deliverance of the emergency department.

When I graduated, Benadryl was a prescription medicine, Tagamet didn’t exist, and Keflex was the antibiotic of choice for staph infections. CAT scanners were only just being introduced to the major hospitals. Heart attacks were treated with lidocaine infusions and bed rest. Electroshock therapy was a common psychiatric treatment. Dilantin was the only seizure medicine. ACLS advocated intracardiac epinephrine injections.

I can hear you all saying, “Okay, Boomer.” Yes, of course, medicine has changed a lot! Of all the amazing advancements, from cardiac catheterizations to genetic manipulation to organ transplantation, the one that has made the most difference has been EMR. Don’t scoff. I started off noting patient records on 5 x 7 index cards, advanced to SOAPs, T-sheets, dictation, and finally the EMR. Just imagine needing a patient’s medical history and having to ask the hospital’s head nurse to rummage through the darkened file cabinet jungle of the M.R. department at 3 a.m. You might as well be asking for the Holy Grail.

When I began emergency medicine, it was considered the red-headed stepchild. E.R.s were staffed by anyone with a degree … medical residents commonly, but even radiologists and psychiatrists, anyone looking to earn a few extra bucks. As JCAHO and government regulations tightened, and under the influence of malpractice insurance companies, hospitals first looked to fill their directorships with boarded E.R. doctors, and then their whole staffs. E.R. residencies proliferated, the demand rising to fill the supply. Those of us with boards could get a job anywhere … at excellent compensation.

Now, though, we’ve filled that cup, and overflowed it. There are too many E.R. doctors graduating every year, so that even pushing out the older guys (ahem) won’t make enough room. We have little bargaining power, as the hospitals can offer lower salaries and fewer benefits and the doctors, laden with debt and desperate for jobs, will take what they can get. Nurse practitioners and other health care provider extenders see patients that used to require an E.R. doctor’s hands. I don’t see a bright future for the next generation.

Yet, the joy of being an emergency physician remains. Those of us who love practicing medicine, the joy of deducing the complicated diagnosis, the thrill of inserting a chest tube, the exhilaration of saving a life, these will always make the practice of emergency medicine fulfilling and inspirational.

– Philip L. Levin

Bio: Dr. Philip L. Levin lives in Biloxi, Mississippi with his French girlfriend and their Pekinese. He served as president of Coast County Medicine from 2014-2016 and president of the MS chapter of ACEP from 2018-2020. He’s the author of 30 published books and over 250 articles, stories, and poems. One can subscribe to his blog at his website: www.Doctors-Dreams.com.