ZJ: Today’s residency graduates are being nearly inundated with the amount of job offers that we are receiving. When you guys were setting up your initial groups, was it more so out of necessity because there wasn’t anybody offering the sort of position you were looking for or because you always had this entrepreneurial drive?
HM: Our hospital didn’t have a need. They had been staffing the emergency department with different people, fly by night, and we came up with a proposal. After working in the emergency department as interns, we essentially ran the department. We had staff on call and another resident above us, but I enjoyed the “episodic-ness” of emergency medicine.
KK: Graduating residents are inundated with opportunities because there are far many more opportunities available than there are residency-trained, board-certified, or board-eligible emergency physicians. Back when you started your group in 1971, I’m sure you had to convince others who wanted to do other things with their life to pursue emergency medicine: “Come join us and be a part of this group while we are considering developing and evolving with this specialty.”
RS: In 1971, when we first started here in San Diego, the idea of emergency medicine as a specialty was kind of unknown. It was just going to work in the pit! It was typically covered by anyone who could be coerced. Of course, there were no paramedics in those days. There weren’t any trauma centers. We were the knife and gun club, and if you heard a honking horn outside, that meant there was a heroin overdose being dumped. We learned after a while, rather than extricate them at great personal risk, we’d just give them Narcan right in the back seat, and off they’d go. We delivered a lot of babies in the ED because women would wait in the parking lot until they were crowning. At that juncture, CAL/ACEP was in its infancy. The importance of leadership in the early days became very clear. That’s when EMPAC [the Emergency Medicine Political Action Committee] came along. Medicare was a problem. Around 1975, we marched on Washington with Terry Schmidt [our part-time lobbyist]. As our advocacy needs grew, along came NEMPAC. There were things we couldn’t do in the ED. We couldn’t intubate in the daytime because that was anaesthesia. We could do it at night because they weren’t around.
KK: That was a great summary. Knowing that we are in a better place as a specialty, which era did you prefer to practice emergency medicine in?
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5 Responses to “Emergency Medicine Founders Discuss Origins of the Specialty, How It’s Changed, and What the Future Holds”
December 18, 2016
Cindy Pearsall Sussman MD FCEPI was sorry to not see a credit given to Dr David Wagner, the real “grandfather of Emergency Medicine” in your article. Dr Wagner was a general surgeon at the Medical College of Pennsylvania in Philadelphia and noted the immense need for an Emergency Medicine residency program. His was the first, and paved the way for many more to come. As a graduate of that program, I am proud to say that we were well prepared for just about anything that came our way. Dr Wagner deserves credit for having the foresight and energy to get the field on its feet.
December 18, 2016
Cindy Pearsall Sussman MD FCEPCorrection- Dr Wagner was a pediatric surgeon
December 18, 2016
MarianKevin,
Thank you for an insightful article regrading the history of emergency medicine and where we are headed.
I find it ironic that there are two articles in this edition of ACEP eNow discussing diversity in emergency medicine, however, your interview panel lacked diversity. I am certain that this was not intentional, but it certainly highlights the unawareness at times of this particular issue.
December 19, 2016
Kevin Waninger MD FACEPEven more important, Dr. David Wagner was a great role model and a really nice man. I am a better doctor, and even more important, a better colleague, friend and father, because of my interaction with Dr. Wagner.
November 22, 2018
Kathleen Nakfoor, Ed.D, MBA, MSIS, RNI had the privilege of working with Dr. John Wiegenstein, MD and Dr. Eugene Nakfoor, MD from 1970 to 1975. I was told “history is being made in this emergency room” and know this to be a fact. I recall working with Dr. Wiegenstein the nights before he head off, yet, to another meeting to battle for EM as a speciality. He entertained us with stories of his less than impressive luggage when checked into the presidential suite. I was well aquatinted with stories of progress being made in EM.
What has been overshadowed by the enormity of ACEP formation and EM becoming a specialty, are the historical changes that were made in emergency department management. I recall Eugene Nakfoor, MD, also a founding ACEP member, telling me stories of the fact no one knew how to bill for services, such a practice was unprecedented. He garnered “departmental status” in which he controlled all hiring and firing of the entire staff.. He and the nurses developed the original scribe system, not the one in existence today. There has never been such a well managed emergency department using the scribe; actually a pivotal individual with whom the department was organized.