As EM physicians, we see firsthand the needs and challenges of our healthcare system and how its many moving parts intersect and clash, positioning us to become the innovators our communities need. And as residents in particular, we have the added benefit of not knowing what “can’t” be done.
When it comes to innovation, our naivety can be fertile ground for solutions, especially if we feel we are safe to ask questions, and if our institutional leadership is willing to explore new strategies.
In your ED, I hope you feel empowered to confront large-scale challenges by questioning the status quo. For example, if your ED has been hit hard by the boarding crisis, learn what community-wide barriers exist to improving flow. Could increased use of mobile-integrated healthcare and community paramedicine alleviate the burden on our EDs for low-acuity complaints? Could programs like Hospital-at-Home alleviate some of the inpatient strain? Where have these programs been studied? Where have they worked well?
As another example, our patients suffer from high rates of opioid addiction, which makes it difficult to control acute traumatic pain. Increased training in nerve blocks would make our analgesia safer and more effective. To consider solutions on an institutional scale, could an EM resident take an acute pain elective month in which they deploy throughout the hospital to perform nerve blocks and other procedures? To think even bigger, could this proceduralist consultant work be a field to responsibly expand EPs’ scope of practice?
A third example is the saturated job market for EPs in certain parts of the country, while rural EDs often rely on unsupervised NPs to provide care. Is it time to push beyond the rural/urban dichotomy? To provide opportunities in rural health for EPs living in a larger city, we need telemedicine. Strengthening telemedicine requires legislative advocacy, regulatory advocacy in licensing and reimbursement, and medical education focused on high-quality telemedicine.
Whatever the issue that makes you most frustrated or excited in EM, you can connect with like-minded residents in EMRA’s 18 committees to discuss it. Learn from each other. Create space for conversations where there are no stupid questions or bad ideas. Connect with mentors willing to lend their support. EMRA committees are where you can gain a deeper understanding of these issues and where good ideas spread like wildfire.
Though our lack of experience usually feels like a detriment, when it comes to innovative problem-solving, it can be one of our greatest assets. Let’s stay curious, embrace the excitement, and shape the future of emergency medicine.