How to Find Your Niche in Emergency Medicine

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How to Find Your Niche in Emergency Medicine

• Glenn C. Hamilton, MD
• Professor and Chair
• Wright State University
• CORD Academic Assembly
• New Orleans, 2008

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• The 3 levels of faculty/
• attending performance
• Baseline level of activity competency/attitude
• What you uniquely give to the organization that
  you also enjoy
• Whatever pertinent or tangential topics you want
  to pursue.

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• What happens if you dont
• cover these three tiers in the Department?

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• Lets redefine Niche
• Its not the Bun or the
• Toppings
• Its the MEAT of your career!

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• Finding the Niche is when
• youve identified specific personal
• characteristics, strengths, and
• interests that DEFINE your
• position in the Department
• (academic or clinical)But
• that alone may be insufficient.

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Linkage Between the Layers

• Importantly, you will have several niches over
  the course of your career
• Individually and collectively, these niche
  performances PLUS a steady fulfillment of the
  Baseline Level of Activity will secure your
  position and likely advancement in the group
• THIS IS HOW YOU BECOME INVALUABLE!

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Making Yourself InvaluableAlternative Titles

• Giving Back to Our Field
• How to be a Team Player
• Follow the Golden Rule
• Infamous vs. Famous?

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• Even in the toughest times, employees can be in
  charge of their own destiny by seeking ways to
  make themselves more valuable to those they work
  for
• said Bob Nelson, a California management
  consultant and author of
• Please Don't Just Do What I Tell You! Do What
  Needs to be Done

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Baseline Level of Activity Competency/Attitude

• Be Positive
• Be Competent
• Embrace Common Sense
• Be Human
• Dont Be Afraid
• PLAN HOW TO MAKE
• YOURSELF INVALUABLE!

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Studies on Attitude

• Death Clock
• Longevity
• Happiness

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I will die at age 96
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43 less years!
I will die at age 53
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58 years difference
I will die at age 37
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Invaluable Available

• Among the most effective becoming invaluable
  strategies is to volunteer to take on additional
  daily responsibilities or to chair task forces
  assigned to tackle cost-cutting or
  customer-service improvements.
• That alone won't be enough to emblazon your name
  on management's "must-keep" list. Workers
  sometimes must go out of their way to remind
  supervisors of their accomplishments, i.e.
  reports
• Don't be a braggart, but be assertive in
  outlining what you have done for your colleagues.

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Available Time Management

• Time can be saved by eliminating unnecessary
  meetings, grouping tasks, minimizing downtime,
  and making use of electronic tools
• Time is more valuable than money, and cannot be
  replaced

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• Keep the following summary BASICS OF TIME
  MANAGEMENT
• List goals and priorities.
• Keep first things first.
• Make and use a daily to-do list, and weekly
  summary.
• Start with the A tasks and not with C tasks.
• Ask yourself, "What is the best use of my time
  right now?"
• Handle each piece of paper only once.
• Treat time as the valuable resource it is.
• Do it now! Complete one task per day minimum!

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Academics vs Clinical Pathway

• Baseline of both defined as above.
• is differentiator actual/philosophical
• Both begin with the End in Mind, but
  ClinicalgtAcademic
• Lets examine 3 Niches in each broad area
• High
• Medium
• Low

Upward mobility in group
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Academics Research Emphasis (High)

• High impact, Highly sought, High risk
• Mobility potential, but only if successful, and
  desired
• In EM, almost everything counts
• Find an area and stay with it

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Preparation for Research

• Heritage
• EMBRS in Residency
• Fellowship 2 year minimum, with
  added degree
• Coat-tailing, mentorship
• Seek supportive environment

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Emergency medicine research directors and
research programs characteristics and factors
associated with productivity.

• METHODS A survey of EM RDs Three measures of
  research productivity were empirically defined
  research publications, grant awards, and grant
  revenue.
• RESULTS Responses were received from 86 of 123
  EM programs. Productivity was associated with the
  presence of nonclinical faculty, dedicated
  research coordinators, and reduced clinical hours
  for research faculty. Programs with an RD did not
  have greater research productivity, using any
  measure, than those without an RD. The majority
  of RDs cited pursuing their own studies,
  obtaining funding, research mentoring, and
  research administration to be major
  responsibilities. The majority characterized
  internal research funding, grant development
  support, and support from other faculty as
  inadequate.
• CONCLUSIONS Research productivity of EM
  residency programs is associated with the
  presence of dedicated research faculty and staff
  and with reduced clinical demands for research
  faculty. Most RDs are professionally satisfied.

Karras DJ Kruus LK Baumann BM et al, Acad
Emerg Med. 2006 Aug13(8)911
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Academics Educator Emphasis (Medium)

• Basic bedside teaching , if none or poor ?
  negative
• Two main tracks Medical Student, Education
  Director in Residency
• New opportunity Simulation Master
• Bonus Education Research

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Preparation for Education Emphasis

• Teaching Fellowship ACEP, early alignment with
  CORD, elements of SAEM, AAMC
• Pursue Faculty Development 1 year Fellowship
• Scholarly writing reviews
• Experience Technology Simulation, US

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Be it Research or Education-Parlay!

• Never do anything once!
• If asked to do a Q/A project
• Make it a study
• Write up the experience
• If giving a talk
• Submit a review article
• If you think a certain method of teaching
  works
• Test it

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Roles in Academics With Less Direct Career Path

• Unless research/education involved
• Clinical Services Chief
• Specialty Services linkage Peds, Crit Care,
  Geriatrics, Trauma
• Ultrasound
• Clinical practice roles (QA/RM, Billing) in
  academic dept.

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• Toxicology / Sports Med / Hyperbarics
• EMS / Disaster Preparedness
• Professional outsider
• IT guru

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Academic career development for emergency
medicine residents a road map.

• Enhance his or her "academic marketability"
• 1) involvement in research
• 2) establishment of a track record of
  productivity via scholarly writing
• 3) awareness of the literature in the specialty
• 4) involvement in specialty organizations and
  hospital committees
• 5) competition for national awards
• 6) gaining education skills
• 7) developing an academic niche
• 8) fellowship training.

Stead LG Sadosty AT Decker WW- Acad Emerg Med -
01-MAY-2005 12(5) 412-6
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Clinical Group Environment

• More important to have the end in mind ?
  Medical Director
• Opportunity at one site is dead end at another
• More serendipity Luck of the Draw
• Few bad tracks still some higher yield

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High Yield Tracks

• Chief of Staff track representative to hospital
• Reimbursement
• Complaint management, incorporates QA, patient
  satisfaction, risk management

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Medium Yield, But Important

• EMS/Disaster varies with setting, competition
• CME support
• Longevity support social and wellness
• IT moving up scale if geek quotient low

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Bottom Line Triple Threats Still Win!

• Old Teaching/Research/Service
• New Admin/Leadership/Attitude

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7 habits

• Habit 1 - Be Proactive
• Habit 2 - Begin with the End in Mind
• Habit 3 - First Things First
• Habit 4 - Think Win Win
• Habit 5 - Seek First to Understand
• Habit 6 Synergize
• Habit 7 - Sharpen the Saw

Bottom Line Its all About You! But only to
the degree youre all about everyone else!
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Habit 7 - Sharpen the Saw

• In this habit, you are the saw and to Sharpen
  the Saw is to become better, keener and more
  effective.

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