After an honorable discharge, he, his wife, and three sons moved to Thermopolis, Wyoming, where he joined a surgical practice (a fourth son was later born there). From 1968 to 1971, he was the only board-certified surgeon in the state. The demand for his skills, combined with his exceptional work ethic, resulted in exceedingly long hours, often causing him to forgo adequate sleep. He would drive back and forth over hundreds of miles from town to town, surgery to surgery.
Explore This IssueACEP Now: Vol 38 – No 12 – December 2019
On the road one night, he developed substernal chest pain. At 35 years old, he was having a myocardial infarction from coronary artery spasm that would end his career as a surgeon and help launch a new academic specialty.
A Career Shift
He later told me that he survived stunningly poor care in a local emergency department. At the time, care was provided in emergency rooms staffed by physicians without formal training. Emergency care was viewed by hospitals as a necessary evil, assigned in academic centers to the most junior house staff, usually without supervision.
Peter’s experience with the death of his father from poor emergency treatment and his own as a patient helped form his vision and conviction that patients in their most vulnerable stage of disease need the most-, not the least-, trained doctors.
After his recovery, he was told to cease surgical practice and find a less stressful occupation. He considered basic science, but the dean at the University of Chicago instead found him a restful, nonstressful position as the director of the division of emergency medicine. When he took the job, he imagined he would simply continue to practice as a surgeon and that emergency medicine would be an administrative duty. However, the responsibilities to his patients and his department soon led to adversarial relations with other specialties, including the chair of surgery, to whom he reported.
Peter perceived that there was a different way to think when managing emergency patients and a different set of responsibilities. As few others had at that time, he saw the need for a new specialty and began to advocate for it. Despite years neglecting emergency patients writ large, physicians from other disciplines who frequently staffed emergency rooms were suddenly threatened by the loss of turf and income that the shift of emergency care to these new-fangled “emergency physicians” seemed to represent.
Peter was joining a movement still in its early stages. He served as a member of the American Board of Emergency Medicine’s original Board of Directors (from 1976 to 1986), which created the certification process in place today. Only a few years earlier, James Mills had written about one of the first EM practices, the “Alexandria Plan.” Community practitioners were just beginning to identify as emergency physicians. The nation’s first EM residency had recently been inaugurated in Cincinnati.