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?