I would like to say congratulations on our 50th birthday. I have not been an ACEP member for all of that time, but I have been a member for some 38 years. While by far not the first, I am among that early generation of physicians who trained specifically in emergency medicine and whose career has been entirely within our specialty. Certainly, congratulations are in order for an organization that is a half century old. Who would have thought in those early days we would make it this far? The overriding issue facing emergency medicine was just to establish the specialty. My aim with this letter is to thank ACEP for all it has done, not just for the specialty of emergency medicine but for me personally.

Back in the early 1980s, as an emergency medicine resident on the East Coast, I was struck by the distinctly neophyte position of our specialty. Being from Michigan, the land of Krome, Tintinalli, Bock, Wiegenstein, and Rupke, where emergency medicine was more established, I found it disconcerting that as an EM resident I was constantly having to explain who I was and that I did plan on working in an “ER” my entire career. Hardly a shift went past where I was not explaining to a patient, another resident, an off-service attending, or a hospital administrator that emergency medicine was a bona fide specialty and that the care rendered in the emergency department was going to improve and grow as the result of residency-trained emergency physicians. That need to explain what emergency medicine was continued as I graduated to the role of an attending physician.

ACEP’s major task at that time was to define the specialty. By going to meetings on a national and state level, I learned to articulate that message. I was also better able to apply those lessons in the various battles being fought on the hospital, local, state, and national levels. Our measure of success is that it has been a long time since I have had such a “justify emergency medicine” conversation. We have gone from being absent on the academic side of medicine to where our presence in academia and medical schools is now well-established. We are now one of the most highly sought-after specialties by graduating medical students.

First, let me say thanks to the dogged persistence of this national organization and my own state chapter for never giving up, never losing sight of the big picture, and for establishing emergency medicine as a leading voice for what is now an accepted part of the house of medicine. We just had an emergency physician as president of the American Medical Association, something unthinkable back in the beginning of my career.

It has often been said by persons of my generation that if you can’t remember the 1960s, you were there. Well, I was there in the early days of ACEP, and I vividly remember those times. I was able to watch those early leaders as they struggled with the issues that shaped who and what we are today. I’m thankful that I found a place not just to speak out but where mentors would educate me and encourage me to speak up. I know it sounds corny or prosaic, but that was and still is very cool. It was the only real Forrest Gump moment of my life, when I was present at the very beginning of an important part of medicine in establishing the first specialty whose foundation was built on what patients needed.

I’m thankful that I found a place not just to speak out but where mentors would educate me and encourage me to speak up.

ACEP and my state chapter mean much more to me on a personal level. I would like to say my career has been a smooth one with few bumps in the road. However, that has been far from the case. I have worked at hospitals that did not deserve or recognize the excellence of the physicians in their emergency department. I have worked for department chairs who were the antithesis of mentorship and did not support the physicians they were supposed to be leading. I have suffered through malpractice suits and, of course, my share of mistakes and being the centerpiece of a mortality and morbidity conference. Contrasting those experiences with others, I have had the extreme privilege of being an emergency physician for truly heroic patients whose courage and humanity were breathtaking, inspiring, and heartbreaking. However, like all emergency physicians, I have also experienced the opposite in patients or families whose petty crassness sucked the joy out of the interaction with them, leaving me saddened and cynical. I have felt the cold breath of burnout and came very close to losing my way.

Among the things that saved me in those dark times were ACEP and MCEP [the Michigan College of Emergency Physicians] as shining lights where I could rekindle the spark that led me to become an emergency physician in the first place. I have often said, “Get a few emergency physicians together from the same shop, and the conversation inevitably ends up devolving into a complaint session about their department, the hospital and its administration, the nurses, or the patients. However, go to a national meeting, the Council meeting, the Leadership and Advocacy Conference, your state chapter meetings, and various ACEP educational conferences and you’ll interact with physicians from many different practice environments.” The conversation elevates to a discussion of interesting cases, mistakes made, lessons learned, finding out that the things you have tripped over have also tripped up other good physicians. It is an opportunity to rekindle the flame and relight the furnace that underlies your love for emergency medicine.

ACEP saved me personally, saved my career, improved me both as a person and a physician, taught me great lessons, and through my activities on a state and national level, allowed me to make a very small difference to my fellow emergency physicians and to the specialty. That was an opportunity I never thought I would have. ACEP and my state chapter leadership saw things in me that I did not. A personal thank you goes to my former MCEP chapter executive, the late Diane Bollman. I am sincerely grateful to all of my colleagues, the state and national staff, the leaders of this great specialty organization, and so many others I cannot begin to name. With this 50th anniversary, I would like to thank them from the bottom of my heart. I hope my activities within the chapter have in a small way repaid some of the huge debt I owe to ACEP and MCEP.

– Bradford L. Walters, MD, FACEP
Royal Oak, Michigan