It's a Wonderful Specialty By Neal E. Flomenbaum, MD, Editor-in-Chief

Somewhere in this country an emergency physician may be reading this between patients on the night of December 24th or 31st. If that’s the case, I would like to begin by saying “thank you” on behalf of all the patients you are treating on this shift, all the people who might unexpectedly need your care during these hours, and all of your colleagues who are able to celebrate the holidays with their families while you are serving on the front lines of health care. Intensivists and other physicians and surgeons who respond to emergencies at night or on weekends and holidays also deserve acknowledgement and gratitude for their sacrifices, but few specialties require as much active duty during off hours as emergency medicine does.

The history of our specialty is replete with acts of personal sacrifice and courage. Before emergency medicine became a specialty in 1979, many talented physicians dedicated some or all of their professional activities to caring for patients in what was then a medical wilderness. In those days, no one seemed overly concerned about certifications and credentials, just as we don’t typically think of the Pilgrims as “undocumented immigrants” or wonder what type of driver’s licenses the first motorists were required to have.

During the late 1970s and early 1980s, there were few trained or certified poison center information specialists and no fellowship-trained, board-certified medical toxicologists. In many cities, emergency physicians from various hospitals volunteered to back up the poison center personnel who answered the phones at night and on weekends. Similarly, before fellowship training in prehospital care became more widely available, most emergency physicians were expected to organize and supervise the EMTs and newly trained paramedics operating in their areas.

There was no expectation of compensation for these activities and little concern about unnecessary exposure to medical malpractice liability. In fact, I recall how happy we were in New York City to learn that the Department of Health had agreed to pay us one dollar a year for our efforts, which presumably meant that the city would be responsible for any malpractice-related expenses and judgments. (I would have proudly kept one of those dollars as a souvenir, but New York City was in such desperate financial straits at the time they never actually gave us the money.)

All this is worth remembering, especially at this time of year and on days when, for no particular reason, nothing seems to go right. We can easily focus on those types of days or, alternatively, try to recall the many patients who arrived in our emergency departments desperately ill or with life-threatening conditions and, thanks to our efforts, returned home and resumed their lives. Unfortunately, however well-intentioned and disciplined we may be, we don’t usually get more than a handful of “follow-ups” from our colleagues or patients.

Perhaps what we could use is a remake of Frank Capra’s classic film “It’s a Wonderful Life,” only this time it would demonstrate how much worse the world would be if emergency medicine had never been invented. Maybe we could call it “It’s a Wonderful Specialty.”

In any case, I wish you all a wonderful holiday season and a happy and healthy new year.

Emerg Med 39(12):8, 2007