An emergency medicine life [PODCAST]

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“I called my wife of 31 days, anxious and dazed. I told her that the pace I was on was crushing me. I told her I had done seven admits since 5 p.m. and taken floor calls, too. It was not yet midnight. I told her I don’t know if I can do this job. But I soldiered on.

It was the first of July.

I picked up my first chart of the shift and began to walk to see the patient. Felt some apprehension. I looked at the chart and noticed the name printed in the box for the attending physician. The name was mine.

I felt awe. I felt pride. I felt fear.”

Duane Corsi is an emergency physician.

He shares his story and discusses his KevinMD article, “An emergency medicine life.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Duane Corsi. He is an emergency physician, and he wrote the KevinMD article “An emergency medicine life.” Duane, welcome to the show.

Duane Corsi: Thank you. Happy to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Duane Corsi: OK. I was born in the city of Detroit, Michigan, and grew up in the suburb of Warren, where I went to high school. I went to Wayne State University in Detroit, obtained a bachelor of science in pharmacy, and became a pharmacist. I worked in an osteopathic hospital for my internship and as a full-time employee for a year, where I learned about osteopathic medicine.

From there, I applied to Michigan State University, the osteopathic school, got accepted, and graduated from there. Then I came back to that hospital system to do my internship and residency in emergency medicine. Since then, I’ve worked for the past 28 years in the Ascension St. John health system in Madison Heights, Michigan.

Kevin Pho: I understand you were also a program director in the past for an emergency medicine residency program. So tell me, what are some trends when it comes to medical students applying to emergency medicine? What are some recent trends, and where do you see the future of emergency medicine going?

Duane Corsi: There’s been a high increase in the number of applicants to emergency medicine. A few years back, it was sometimes almost difficult to field the entire class, whereas now we’re getting 600 to 800 applicants a year for eight spots a year. There’s a much more diverse population of residents coming from all over the country, and really all over the world. We’ve had foreign residents, even from as far away as Africa, in our program. But other than that, they’re still strong. They do well, they’re eager to learn, and we’re happy to have them.

Kevin Pho: You mentioned some characteristics already, so that kind of foretells my next question. As a program director, what were some qualities that you looked for in medical students that would make them strong emergency medicine physicians going forward?

Duane Corsi: Yes. I looked for candidates that were self-starters, that knew what they were getting into with emergency medicine. A lot of medical students don’t really know the stress involved in working shifts in emergency medicine. You really have to be a go-getter. You have to be willing to pick up those charts, go see the patients, form your plan, present it to the attending, and then want to learn procedures and things like that. That was really the main thing I looked for in a candidate.

Kevin Pho: You mentioned that some medical students aren’t sure about what an emergency medicine life would be like. So go into more detail. What are some things that you want prospective medical students or prospective applicants to know about emergency medicine?

Duane Corsi: Well, it’s shift work. If you think about it, Monday through Friday from nine to five is a very short amount of time during the week, so the majority of your time working, you’re going to be working some days, and you’re going to be working a lot of afternoons, a lot of midnights, a lot of weekends, and a lot of holidays. You’re going to miss a lot of time with your family and friends, because when they’re off, you’re going to be working. They maybe don’t understand, when they’re starting, how tough that can be.

Also, it’s very stressful while you’re there. You may have 20, 25 patients that you’re taking care of in a shift, and many of them are critically ill. Others are not so ill, but they may be disrespectful and even aggressive with you, and some people aren’t ready for that. It wasn’t what I was totally expecting when I went into it. I started 40 years ago, and you thought respect for physicians was still there. But in an emergency department, people are having their worst day. Many of them are intoxicated, or they have mental illnesses and things like that, and it’s hard to deal with that. A lot of prospective residents may not be able to understand what they’re going to have to deal with.

Kevin Pho: All right, so let’s transition now into your KevinMD article that you wrote. It’s titled “An emergency medicine life.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Duane Corsi: Usually around July 1. I don’t know any other profession where one date is as important as it is in the medical education field, because that is the day when all the newly graduated medical students start to become real physicians as first-year residents. So you go from June 30, when the department and the residents are running like a well-oiled machine, literally, to the next day, when you have interns starting their very first day taking care of patients on their own, with supervision, of course.

A lot of times we tend to make jokes about July 1: “Oh, there we go, July 1. It’s going to be miserable. The intern is going to be asking me, ‘Oh, can I give a Tylenol for my patient with a headache?'” That kind of thing. I was guilty of that too. So I thought, let me write about July 1 being a little more meaningful, and about what I went through.

My July 1, I remember it well: calling my wife, saying, “Oh my God, I don’t know if I’m going to be able to handle this.” And then going to your first day as an attending on July 1, and you see your name on the chart, and how that hits you. You’re excited, but there’s also still some trepidation and some fear, because it’s your first day as an attending.

Then, when I got into medical education, July 1 became the transition point. And yes, it’s difficult, when you’re cruising along with well-oiled residents, to go back to interns that have to start all over again. But later, as you get a little bit older and you can look back, July 1 is actually a day that should be revered and not feared. It’s unique to the medical profession, and that’s what I was trying to talk about.

Kevin Pho: Now, for those new medical interns and residents who just on June 30 were medical students and on July 1 are physicians practicing, what kind of advice do you have for them in making that transition?

Duane Corsi: You have to step it up, because you are the physician now. This is why you wanted to go to medical school. But don’t worry, the attendings are here. I’m here with you. I’m not going to let you make a mistake, but I do want you to spread your wings and learn to be a physician. You are a doctor now. You will be in charge of patients, and really, when you’re on a night shift, you’re really by yourself. I mean, you can make phone calls and things like that, or maybe ask a more senior resident, but you need to want to learn what it’s like to be a physician.

There are no grandstands in the emergency department. You’re not going to learn by looking. You have to do. You have to make decisions. We will help you, but it’s time to fly on your own now.

Kevin Pho: You’ve been a program director and emergency physician for decades now. Any particularly poignant July 1 stories that come to mind over your decades of experience in the ER?

Duane Corsi: No, just as I wrote in the article, seeing the new interns come in with their nice clean white coats, although many of them don’t wear white coats anymore, eager and ready to go. It happens pretty much every year. They’re very excited to get going. At orientation, I would usually ask them, “How many of you are excited, and how many of you have some trepidation?” Usually the honest one would raise his or her hand for being somewhat fearful, because I know I was too, and it’s just natural. But that said, I don’t remember any one specific encounter that would have been poignant.

Kevin Pho: I’ve asked a lot of questions about your past and experience in emergency medicine, so I want to switch gears and look toward the future of the emergency medicine profession. What do you see as some of the trends affecting emergency physicians? Because on my physician Facebook group, I’m seeing a lot of emergency physicians out of work. A lot of departments are getting bought out by private equity and whatnot, and I actually see emergency physicians looking for jobs. From your view, what are some of the trends that you see?

Duane Corsi: Yes. I mean, when I started out, so many years ago, you could go anywhere in the country. Then a couple of cities kind of got buttoned up, like L.A. and Denver, places where everybody wanted to live. But now we’ve gotten to the point, yes, with private equity. I started out as an employee of the hospital, then in a private group, and then a contract medical group bought out our private equity group. They seem to want to be more involved in the financial aspect and not really the patient care aspect, so they’ve cut hours, and they’re hiring more advanced practice providers that probably cost a little bit less.

COVID had something to do with it, because initially we were so hit by COVID that we were very busy. But then people stopped coming to the emergency department because they were afraid, so across the country, volumes actually went down. Now they’re back up again, but during that time, the contract medical groups cut hours, cut positions, that type of thing. So yes, my residents last year had a hard time finding jobs, all of them. They all eventually did, but they couldn’t necessarily go where they wanted to go. So the trend seems to be to bring in more advanced practice providers and fewer physicians.

Kevin Pho: Now, against this landscape, what kind of advice do you have for current emergency physicians, when so much around them, financially, economically, and in terms of practice environment, is changing?

Duane Corsi: I would tell them to probably stay where they’re at, especially if they’ve built up a reputation where they’re at. Even if a contract medical group comes in, you may have to stick it out, because you may have a hard time finding somewhere else to go, whereas before, we could move around anywhere we wanted to go, pretty much. So I would say be careful, because if they’re not aware of that, especially if they’re not in medical education and they’re not dealing with new graduating residents that are having a hard time, they might not be aware of the fact that it’s difficult to change jobs now.

Kevin Pho: We’re talking to Duane Corsi. He’s an emergency physician, and he wrote the KevinMD article “An emergency medicine life.” So Duane, during this interview we talked a lot about the challenges facing emergency medicine. But as you reflect on your career, tell me some of the rewards that emergency medicine gave you.

Duane Corsi: Oh, the rewards are that you get to save lives on a regular basis. There’s nothing better than when you make your first save, whether it be a heart attack, a stroke, an overdose, a gunshot wound, or major trauma, and you’re able to handle that and stabilize the patient. I mean, if we don’t do our job and stabilize the patient, they’re never going to make it to the surgeon, and never going to make it to the intensive care unit. So that’s the most rewarding thing.

Other things that you might not think of would be the family dynamics that you come in contact with, an elderly parent and the children, end-of-life type of things, where you can help with that. That’s very rewarding too.

And really, for me, later in my career, I found that seeing my graduating residents, who started out on that July 1 not knowing much and being very green, then going out in the world and becoming program directors, becoming directors of their departments, writing articles, and taking care of patients even better than I could do, that became more rewarding to me than even saving a life was: that I had a role in bringing these young physicians and turning them from medical students into somebody who could take care of life-threatening critical situations.

Kevin Pho: If you were to choose your specialty all over again, would it be emergency medicine?

Duane Corsi: Yes, absolutely. I have no regrets.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Duane Corsi: I would just say to embrace July 1. Don’t fear it. It really can be very rewarding to bring in these new medical school graduates and nurture them. Expect that, yes, it’s going to be a little bit harder to work with them to bring them along, but the rewards, once you do, when you look back, are fantastic.

Kevin Pho: Duane, thank you so much for sharing your time and insight, and thanks again for being on the show.

Duane Corsi: Thank you, Kevin.

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