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There are many issues facing emergency medicine, but the biggest issue for me is physician satisfaction. Happy doctors make happy nurses and happy patients. There are many metrics that emergency physicians face, from door-to-doc to door-to-antibiotics and door-to-balloon.

I want emergency physicians to have the best door-to-home metrics, feeling after every shift that we made a difference—because we do.

There are many employment models in emergency medicine, and I want to share my story of going from a large group to an independent group to creating a setting that provided me with the best of both worlds. While I am protective of my practice model, I don’t think it matters where emergency physicians work as long as they are highly satisfied.

I started my career in emergency medicine working for a large group practice at Mercy Hospital in San Diego. I felt like I won the lottery working at a community hospital with all the fixings of trauma, academics, inner city, and action. I was even given a special role as educational director. While I became very committed to my hospital and community, my colleagues and I became disillusioned with our management group. The group sold for several million dollars, and this had a negative effect on our income. The cost of the sale was paid for by the labor of the working physicians.

At that point, we lost a few doctors, but there was a core of us who were committed to the institution and our community; we didn’t want to leave. The final straw came when the group sold for a second time. Our doctors were beyond angry. Each monthly meeting was contentious and emotionally exhausting. At $78 per hour, we did not care about excuses of bad payer mix, improved productivity, or future solutions. We hated the current buyer, whoever it may be, as we lost faith and wanted no part of any more sales.

It was Dec. 31, 2004, and each doctor was told to either sign a contract with the new buyer or get replaced. I didn’t want to sign. However, at the last moment, and after some sweet phone calls from trusted colleagues, I was the last to sign, but there was a catch. My colleagues and I added a clause that would free us in one year and would allow us to compete for the business—and compete we did. We spent the year creating a business plan and securing our future. We won our bid for independence. It was like the Fourth of July, breaking off from the taxing king to form our own country. Overnight, we went from the most disgruntled group of doctors to the happiest group ever. We all agreed to go without pay until our accounts receivable came through, and in a short time, we were making much more money and were more productive.