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Join Yang Wang, an emergency physician. Explore the unique challenges and rewards of emergency medicine, the evolving landscape of the field, and the qualities that make someone an ideal fit for this demanding profession. Discover insights into maintaining passion and purpose in a career that revolves around saving lives and navigating the complex world of health care.

Yang Wang is an emergency physician.

He discusses the KevinMD article, “The rewards and challenges of emergency medicine.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Yang Wang. He’s an emergency physician. His KevinMD article is titled “The rewards and challenges of emergency medicine.” Yang, welcome to the show.

Yang Wang: Thank you. It’s great to be here.

Kevin Pho: We’ll get to the article in a little bit. First off, briefly share your story and journey.

Yang Wang: I’m an emergency medicine doc. I grew up on the East Coast, in Maryland. After college, I felt medicine was the right choice, and I didn’t really want to pay for it or take a lot of loans out, so I found the Air Force as a way to go through medical school. It was a little unfortunate, I guess, but also fortunate in many other ways later on, that I commissioned about four months before 9/11. So when I was in medical school, I was reading a lot about what was happening overseas, what physicians were expected to do and what they were doing, and I was really looking forward to that.

I decided on emergency medicine a couple of years into medical school and did my residency at a civilian hospital, MetroHealth Medical Center in Cleveland. I met my wife in medical school, so we both did our residencies in Cleveland. Afterward, we decided we wanted to end up in the Bay Area, because she wanted to pursue fellowships, and there was an Air Force base just north of San Francisco, about an hour away. So I was stationed there for four years, served as an ER doc and deployed a couple of times. After my service time was up, my wife had found a full-time job here in Oakland with Kaiser, so we just stayed. We got to the Bay Area in 2009, and we’ve been here ever since.

Kevin Pho: So we’re going to talk about the state of emergency medicine. There’s been a lot of discussion about the challenges facing the field, and I’m sure you’re aware of the latest match numbers when it comes to emergency medicine. You talk about the rewards and challenges of the field in your KevinMD article. So tell us, how did your article come together?

Yang Wang: It actually came together right after the match. My hospital is affiliated with the Highland emergency medicine program, and even about a year or two before this year’s match, when the workforce study report came out from ACEP forecasting a surplus of ER physicians in 2030, we talked about what the job prospects were going to be for the current residents. Then, sure enough, the match came out, and a lot of places had to scramble to fill their positions. Unfortunately, one of those was my own residency, which has been around for a long time. It’s a county program, it’s well respected, and it was surprising that they were not able to fill all their positions.

Around the same time, we were finally starting to see our volumes come back in our emergency department. During COVID, our volumes had dropped, and we had to downsize our physician group. But as the volume started to come back, I found myself in a place where I had to start really hiring and looking for candidates. So the combination of medical students entering emergency medicine and my own experience doing recruiting, finding out what people are looking for and what they’re no longer interested in, is what drove me to write what I wrote.

Kevin Pho: One of the things you mentioned earlier is that it was surprising your residency couldn’t fill this year. Why was it surprising? Did you have no warning, or any foreseeable reason why this could happen?

Yang Wang: I didn’t know. MetroHealth has been a staple medical provider for the Greater Cleveland area. They have a very well-respected Life Flight program and a very good trauma and burn program, and an affiliation with Cleveland Clinic, which is a fantastic institution. So I guess I just didn’t expect these old-school, well-established programs to be victims of the match.

Kevin Pho: What are some of your theories and reasons why a lot of emergency medicine programs didn’t fill this year?

Yang Wang: I think there are probably a couple of things that come to mind right away. The first is certainly the pandemic. This was the 2023 match, so COVID had been around for a couple of years, and it really hit emergency physicians very hard. Initially, for that first six months to a year, not knowing if you had enough PPE to safely provide care for your patients, and then coming home and not knowing if you were going to give it to your family, was really stressful. Then, after the first phase, the perception of health care workers changed a little bit. We were no longer those health care heroes, and there was a lot of doubt and skepticism about what the medical community was doing, and whether we were doing the right things for our patients or had secondary motives. And on top of all of that, the things that already make emergency medicine hard, I think, probably made the mentors of medical students who wanted to pursue emergency medicine really doubt whether this was a good field. Seeing people burned out, really tired and really stressed would certainly affect how candidates decide what specialty they want to go into.

The second thing, though, is the workforce report. This is my personal opinion, and honestly I don’t know that the data back this, but reading that workforce report, if I were an incoming resident looking for a specialty, hearing from the American College of Emergency Physicians that there was not going to be a job for me, that there was a high likelihood I would be surplus, I would ask, “Why would I enter a field where people are burning out and tired, and then, when I come out, I might not even have a job?” Those were probably the top two things I can think of. I’m sure there are a lot of other things.

Kevin Pho: So let’s talk about that second point, the job situation for emergency physicians. I know there’s a lot of pressure on the field from things like private equity, and from the fact that a lot of programs are using more nonphysician practitioners as emergency clinicians. How accurate is that? What are you seeing on the ground in terms of job prospects for emergency physicians?

Yang Wang: I think for graduating residents and other ER docs looking for jobs, it’s their market right now. I live in the Bay Area, and I know a little bit about some of the groups in my area and a lot about my group, and we are definitely hiring. I think everyone has recognized that burnout is real and that we need to mitigate it by making sure we have staffing, and now the volume has come back and there is a need for staffing. Whether that staffing should be done by advanced practice providers or physicians is a very tough question, depending on who your patient population is, the complexity of their illness, the acuity, the volume and the priorities of the group that’s hiring.

My group does have APPs. We have a fantastic relationship with our APPs. I love those guys; they’ve been around for years. That being said, they’re not physicians, and we recognize that we all have our own different roles in providing care for our community. But we’re a small, independent group, so we tailor the care we provide and the staffing we have to what our patients need. In hearing from some of my friends who work for larger national groups, I think that nuance, and that ability to really tailor care to what your community needs, can be a little lost when your boss is in the Midwest and is in charge of making sure everybody is staffed.

Kevin Pho: So despite some of the difficulties you mentioned, you’ve been practicing emergency medicine for more than a decade now. Tell us some of the rewards you feel practicing emergency medicine today.

Yang Wang: I mean, this is a fantastic job, and I’m still so grateful that I get to do it. Every physician probably goes through this, but my sense of why I do what I do, and what I find rewarding, has changed over the years. I came out of residency feeling like I wanted to do all the traumas and all the critical interventions, to use all the skills I’d learned as much as possible. In the beginning, it really is about the medical knowledge, the evidence-based medicine, the procedures and all of that. But after you do that for a while, you get used to it, and it’s no longer very hard technically. At the same time, I started to recognize that it is a real privilege to be able to sit down in front of a patient and have them tell me their story: why they’re here, but also what brought them here over the past six months to a year. When you’re a doctor and you sit in front of a patient, the wall that people always put up between themselves and some random person they meet on the street goes away. We as physicians have such a pass into the lives of everybody we see, and that has become so much more rewarding to me than the mega code that comes through.

Kevin Pho: Now, for medical students who may be listening to this particular episode and hearing all this negativity around emergency medicine, tell us some of the questions they should ask themselves to make sure emergency medicine is the right field for them.

Yang Wang: The reason I went into emergency medicine probably comes from the same reason I found value in the military, and it’s service. It’s providing that care and giving back to people I don’t know but who are part of my community, and that community can be defined as the five-square-mile radius I live in, but it could also be defined as people who share a common value. That service commitment, though, doesn’t necessarily mean you get thanked on a regular basis for what you do, and I think in emergency medicine it is hard to find a lot of gratitude from patients and from other doctors.

I’ve said this over and over again to medical students and residents who have come through talking about choosing an emergency medicine career: You have to be comfortable with not being the doctor patients always bring gifts to. You have to be comfortable with knowing that you’re doing the right thing, and that there’s an internal validation to what you’re doing, because it’s unlikely you’re going to get a lot of external recognition. Patients come to the ER, and most of the time they’re scared; it’s probably the worst day of their life, or they’re at the end of their rope because they don’t have anywhere else to access care, and they’re probably a little skeptical that you will help. So you may not walk away from all your shifts feeling like your patients were really grateful. I tell people that you have to be OK with that, that you have to be somebody who is looking to practice medicine not for the accolades but for the conviction, the knowledge that you’re actually doing the right thing.

Kevin Pho: We’re talking to Yang Wang. He’s an emergency physician. His KevinMD article is titled “The rewards and challenges of emergency medicine.” Yang, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Yang Wang: I don’t want people to feel despairing about emergency medicine. There’s a lot of talk about burnout, but I want to remind folks who have been practicing as long as I have or longer, and also folks who are just entering the field or considering it, that there are so many wonderful rewards in seeing what life is. The emergency department is a place where you really get to see all the things that make life what it is, all the pains and all the joys. Remember that, and remember what we do. I think it was Dr. Mel, from EM:RAP, who used to say at the end of every EM:RAP session, to remind all of us, that what we do matters. That hasn’t changed. What we do does matter. It is hard, and burnout is real, but let’s help each other and remember all the good things that come from being in this field.

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

Yang Wang: Thank you for having me.