Mindful Solutions to Dealing with Patients

By Megan McGrane, PA  mcgrane
What do you know about mindfulness? Jon Kabat-Zinn, the father of the modern mindfulness practice, is a professor at the University of Massachusetts Medical School.  He describes mindfulness as the practice of being fully present in each moment, clear from distraction (1). Best put, mindfulness is paying attention “on purpose.” So why am I telling you this? And what does it have to do with your day-to-day in the emergency department?

Mindfulness is certainly not a concept broached by most medical training programs.  However, mindfulness is a practice that has been in my life for almost a decade and is integral in my interactions with patients in the emergency department.

I understand you may be thinking, “So, what does this mindfulness thing have to do with helping sick patients?” Let me tell you how this practice has everything to do with emergency medicine and how I believe it can revolutionize the way you interact with patients and families.

We have all been there. It is Monday at 5 p.m., a patient has been waiting for a few hours and now you are telling them they need a study that could take an additional two to three hours to complete. Maybe you have a patient in a hallway bed that is constantly being shuffled past and bumped into as stretchers round the bend in the busy part of the department.

Perhaps a patient’s blood draw was lost or misplaced and never made it to the lab. Frustration can ensue in any of these scenarios, and they are far from ideal for all parties involved. Let me give you a few techniques that use mindfulness to help you “pay attention on purpose” and ease your interaction with patients.


It is easy to take shallow, rapid breaths when we get angry, anxious or stressed. Often we are so unaware of this habit that it never even occurs to us.  In a frustrated moment, taking a deep breath in through your nose, holding for four counts, and then breathing out again is a great technique to slow everything down. I often do this when a patient is raising his voice with me or is becoming increasingly frustrated. It helps me to slow down and respond rather than react.

Listen. And then Pause

The empty spaces in conversations can be uncomfortable. That is, until you get used to them! Practice allowing a few seconds to pass before speaking or responding when a patient is voicing concerns; this practice can make a huge difference in how the conversation goes. It allows you time to process what has been said, take a breath, and then respond. It also gives patients a chance to know they are being heard. Sometimes they also may take this space to continue their thoughts if needed.  Allowing a pause in conversation tells patients you are taking time to think about what they said, not just give an instant reply.

Allow Room For the Patient to Ask Questions

Asking at the end of each interaction if the patient has any questions for you and then PAUSING (as in #2) gives the patient time to think of anything he or she might not understand about what you have said or what is happening during the visit. “What is a CT?” “How long do I have to take this medicine?” “What happens when you do this procedure?” This is a simple tip taught in the early stages of medical education that’s easy to skip over in the fast-paced emergency department.

Remember, It is Not About You

The ER is a familiar place to us as healthcare providers. We spend many days (and nights) in these halls. The dinging of monitors and overhead pages are like white noise in our day. However, for our patients it may be their first time in a hospital, not to mention a busy emergency department.  The patient or a family member may be experiencing a health crisis.  Often anger, frustration and irritation are multifaceted, and in the ER setting, they are inextricably linked to fear and pain. Using mindfulness and breathing strategies during a tough interaction can help remind you of this: it is not about you.

(1) Mindful Medical Practice: Just another fad? Can Fam Physician. Aug 2009; 55(8): 778–779.

Megan McGrane, PA,  is a full-time emergency department physician assistant at Saint Barnabas Medical Center in Livingston, N.J. She received a bachelor’s degree and a master’s degree in exercise physiology from the University of Pittsburgh and holds a second master’s degree from University of Medicine and Dentistry of New Jersey (UMDNJ/Rutgers), Piscataway, N.J. She is a member of the American Academy of Physician Assistants.

Quick Tips with Dr. Marc Milano

By Marc Milano, MD, FACEP Marc Milano, MD

Topic: Patient Satisfaction

As emergency physicians, we find each day different from the last. We are constantly faced with new patients, new illnesses and new challenges.

But regardless of the day, our focus always is on providing the best care for the patient. And while situations inevitably arise in which patients and their family or friends can become aggressive and outwardly frustrated, there are tips to remaining calm, alleviating frustrations and improving patient satisfaction.

Treat Everyone in the Room

In the emergency department, patients are often accompanied by friends and family members. This is especially true with the very young and the elderly. They need support during times of stress and uncertainty. You can use this fact to your advantage if you follow some simple guidelines.

  • When you enter the room, introduce yourself to the patient, then to their family members and friends.
  • Find out how the guests are related to the patient.
  • Address both the patient and the guests but keep your primary focus on the patient.
  • Don’t show that you are frustrated by questions from the group. Simply let them know that you will answer them when you are done evaluating the patient.
  • Show empathy toward caregivers and acknowledge their hard work in caring for a sick loved one.

When you’re done with the evaluation, explain your plan, how long you expect the visit to take (OVERESTIMATE!), and then ask the group if they understand. Doctors sometimes are afraid to ask “Do you have any questions,” as it might open the flood gates. However, I’m frequently shocked that the patient and companions have none. Another way of addressing is to ask the family “Does all of this information make sense to you? I know it can be overwhelming.”

You can then get them involved in the patient’s care plan by asking them to help the patient with things like drinking contrast, using the call bell for help or letting you know right away if something changes with the patient.

When you master these concepts and incorporate them routinely into your practice, you’ll rarely have to do “damage control” with an angry family member.

Keep Calm and Treat the Patient

It’s not uncommon to be confronted with an angry or aggressive patient in the emergency department. This is one of our biggest challenges, but handling it well can result in a good outcome, not to mention that it’s a really rewarding feeling to be able to turn a patient’s frown upside down! Be nice, and show compassion and a strong desire to make things right.

First, do not ignore the elephant in the room. If you know what the problem is, confront it directly. Saying things like “lower your voice” or “calm down” almost never help the situation – and in fact generally inflame it. I use phrases like, “I’m Dr. Milano, and I’m here to help understand the problem and do everything I can to fix it.” Sometimes this alone can turn the tide.

Often the anger is about waiting time, so I will offer something like, “I will do everything in my power to expedite your care, without compromising the quality of it.” You must then be prepared to deliver on that promise; however, as failing them again will just cause a re-escalation. Get on the phone with the lab/radiology, etc., and explain the situation. Let the other staff members know what’s happening and reassure them that you have already calmed the patient, but you need their help the keep things that way.

Occasionally, the anger or frustration is due to an unrealistic expectation (think MRI of the finger on a Saturday at 3 a.m.). This is an opportunity to educate the patient as to why a particular treatment or test is not warranted, and maybe explain how it might be harmful or could waste even more of their valuable time. Explain that you will treat the pain, stabilize the problem and provide appropriate referral and guidance to get the problem solved. I will say things like, “My main goal is to rule out the serious things, treat your pain, and then point you in the right direction.”

The ED is full of challenging medical situations. We are on the front lines of the war against death and disease every day. We occasionally make the seemingly miraculous happen. It seems like that should be enough, but our pledge is to treat the whole patient, the whole situation and always to give our best effort.

Marc A. Milano, MD, FACEP, is chief of the department of emergency medicine at Bayshore Community Hospital in Holmdel, N.J. He serves as physician head coach of the Patient Satisfaction Coaching Program at Emergency Medical Associates, an emergency medicine practice headquartered in Parsippany, N.J. Dr. Milano received his undergraduate degree from Rutgers University, his medical degree from St. George’s University in Grenada, and completed his emergency medicine residency at Newark Beth Israel Medical Center.

Medical Research: All Evidence Isn’t Created Equally

By Phillip M. Stephens, DHSc, PA-C Image

The “research police.” It’s a title every medical provider needs to embrace these days. Our evidence-based medical system is increasingly overwhelmed with data, and if there’s anything worse than no data, it’s bad data.

We like to think that physicians are comfortable navigating medical literature, but in reality much is hidden from physicians or purposely buried. Mark Twain was right; there are three kinds of lies: lies, damned lies and statistics.

Research about research is a new phenomenon on the rise to combat the problem. The initial findings are startling.

In 2010, Harvard researchers examined the drug trials of five major classes of drugs measuring only if the trials were positive and who sponsored them. After reviewing more than 500 trials, they found 85 percent of industry studies produced positive results while only 50 percent of government-funded studies were positive.

In 2006, researchers examined 542 drug trials for psychiatric drugs during a 10-year period. Again, industry-sponsored studies favored their drug 78 percent of the time compared with 48 percent of independent trials.

Publication bias affects every field of science. Numerous groups have tried to reproduce studies published in academic journals, and when they fail to reproduce the results, the same journals refuse publication. Many are simply not interested in negative results.

In March 2012, Nature magazine did publish the results of a study in which researchers attempted to replicate the results of 53 studies in cancer research. They were able to reproduce only six.

The core issue that affects evidence-based medicine is that if you conduct 10 studies and physicians get to see only the five that favored the tested drug or treatment, that’s a problem. So what do we do?

While publication bias and selective referencing certainly exist, things slowly are changing. We now have open-access journals, which publish any human research trials whether positive or negative. There also is a push for registration of trials, although this hasn’t been aggressively enforced. Independent systematic reviews are a huge help and should be on the reading list of every medical provider. Specifically, the Cochrane Collaboration is a gold standard for evidence reviews since the 1980s. But there is more we can do.

Insist on Better Data

Whether interacting with the pharmaceutical industry or policymakers, insist that all of the data is provided for trials and that policies are developed to ensure good methodology from your local medical center, the Food and Drug Administration (FDA) or academic journals. Cochrane finally persuaded the maker of Tamiflu to release all its data after such a campaign, and Nature magazine subsequently published the Cochrane/Tamiflu controversy.

Teach Medical Students How to Spot Bad Evidence

Preparing the future generation of medical providers to defend themselves against industry marketing or flaky evidence is imperative. Critical thinking skills and research methodology should be a core measure of every medical curriculum.

Professional Organization Involvement

Every medical association is a needed watchdog concerning medical evidence through best practices committees and policy statements.

Critically Appraise Data Independently

It’s time consuming, but using Cochrane and other independent systematic reviews gets us only part way toward good data. Just as you have a system for reading an X-ray or interpreting a set of lab results, develop and teach a system of examining research beyond simply reading the abstract.

This involves:
Scanning the abstract

  • Identifying the research problem and its logical consistency
  • Examining the literature review for balanced critical analysis
  • Identifying the theoretical framework, research question and hypothesis
  • Reviewing the methods: the sample size and target population, and how the data was collected and analyzed.
  • Noting any ethical considerations and especially the methodology
  • Examining the procedures, variables, analysis and discussion
  • Noting the level of evidence
    • Remember: all evidence isn’t created equally. Level 5 evidence is considered “expert” opinion, which could mean three guys in a room thinking it’s a good idea to level 1a evidence, which is a “systematic review” with heterogeneity of variables.

The process of how we generate and interpret evidence-based data is currently not a predominant part of medical education, but in a world of evidence-based medicine, it should be. With an increasing level of evidence needed to feed evidence-based practice, faulty or misleading data is the next public health hazard. So when the news media announces one day that coffee is bad for you then the next day unashamedly says it’s good, question the evidence.

Phillip Stephens, DHSc, PA-C,is the associate practitioner site director for Emergency Medical Associates at Southeastern Regional Medical Center, Lumberton, N.C. He is adjunct faculty at A.T. Still University in Mesa, Ariz., where he teaches Research Methodology and has practiced as an emergency medicine physician assistant for 25 years.

How to Make the Most of Your Emergency Medicine Residency

By Shilpa Amin, MD, FACEPAmin

Dr. Seuss said it best: “Congratulations! Today is your day. You’re off to great places! You’re off and away! You have brains in your head. You have feet in your shoes, you can steer yourself in any direction you choose.”

You have worked extremely hard to get into your residency program, now make the most of these important years! Each year is a stepping stone to help you find the perfect job; you are the person who’ll decide where to go.

There is no manual to surviving residency, but there are a few pieces of advice I’d like to offer.

Intern Year: Learn the basics. There is no real substitute for understanding the fundamentals of teamwork, hard work and efficient work. When you are an intern, you are working the most shifts, doing many procedures and learning to absorb direction from many people: senior residents, attendings and consultants. Take this year to really understand how the ED functions, because the operations of the ED are unique. Use this year as a base for success for the rest of your residency. Ask lots of questions. Read when you have time. And most importantly, HAVE FUN.

Junior Year: Be a mentor and true teacher to the interns. Remember the saying: “See one, do one, teach one.” You will quickly learn procedures and how to care for critically ill patients. Strive to be a strong leader in your junior year. This year you will have more time to read and more time to network.

  • Start talking to the seniors who just graduated and see where and how they found their jobs.
  • Align yourself with colleagues who work in a setting that you see yourself in (academic, community, administrative).
  • Attend national conferences such as ACEP, AAEM or SAEM . Visit the booths and speak to other physicians about what they like most (and least) about their jobs.

Use this year to build a foundation for your job search. Toward the end of your junior year, begin researching different employment models, consider if you want to apply for a fellowship and where geographically you want to practice. Begin drafting an initial version of your CV and have your program director and other faculty review it to help you revise.

Senior Year: This is when the job search is in full effect. Use the summer months to network, learn what an independent contractor is – speak with your accountant or adviser to see if this is the right fit for you to help better understand the job market. Reach out to alumni from your program for more information. Your program director and chairman also are great resources if you’re looking for a job in a location that you’re not familiar with. Begin thinking about who you are going to ask to fill out your references for your applications. Finalize your CV and write a cover letter. Begin sending out emails to the EDs you are interested in applying to.

September and October of senior year is when most residents start interviewing. Give yourself enough time during each interview to spend time in the ED and shadow one of the doctors for a few hours. This will give you a real sense of how the ED functions as a system and works as a team. Interview at enough places to give yourself a broader understanding of the different work environments available to you and where you would fit best. I recommend researching and preparing questions in advance of each interview. Ask for a current copy of the schedule. Be sure to fully understand compensation and scheduling, how vacations work, and what type of malpractice coverage you will have.

In November and December, review all of the information obtained from your interviews.

  • Ask yourself where you will be most happy and have the most successful career.
  • Ask your mentors to sit with you and decipher the information and assess each site.
  • Review your contract and have a contract attorney review it for you as well, specifically examining restrictive covenants and any confusing language.
  • As a courtesy, let anyone who extended an offer that you don’t accept know where you decided to start your career.

“Today is your day! Your mountain is waiting. So, get on your way!”

Shilpa Amin-Shah, MD, FACEP, is a full-time attending emergency physician at Saint Barnabas Medical Center in Livingston, N.J. Dr. Amin is also the Director of the Physician Recruiting Team with Emergency Medical Associates, Parsippany, N.J. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine and served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and two young children.

10 Tips for Success for Healthcare Newbies

By Kathleen Gardell Keyboard

As a child I longed to be a dancer. When deciding on a college major, I opted for dance. After an injury and many talks with my parents, I decided to switch majors and graduated with a degree in nutritional science with a dance minor. The path I’ve traveled to become a regional manager of our medical scribe program can be described as many things, but non-traditional would be the most accurate.

I spent a year traveling as a medical scribe for my company’s Site Support Team — a group of clinicians, scribes and support staff deployed to new client locations. Because I traveled to several different sites during this time, I became familiar with various ED sites and networked with a lot of medical directors, physicians, mid-levels and hospital administrators.

Through networking, I was presented with the opportunity to become a regional manager of the clinical information manger (CIM) department. This happened at the perfect time in my life. I was about to get married and knew that I soon wanted to put down roots and have a more regular schedule–although now I do have to admit that I do miss that random Tuesday or Thursday off that I would have with shift work.

I’m often asked by newly hired scribes what’s the best advice I can give them for succeeding in the position. It’s hard to narrow it down to one tip because I’ve learned a lot of lessons in the 10 years I’ve been in healthcare. Although my advice is not based on any proven theories, these are the top 10 things I’ve learned so far:

1. Know Yourself.

This sounds simple and straightforward enough. However, knowing yourself also means being able to recognize changes in yourself and then making informed decisions about your future based on those changes. For example, we are never the same person at the beginning of a journey that we are at the end. Being able to recognize what changed you and how will help you make better decisions about your future.

2. Pay Attention.

This means actively listen to your peers, your subordinates, and your superiors. Go into work every day with the intention of listening and learning. If you do, you’ll leave work every day having learned something new.

3. It is OK to Give Things Time.

This is even harder for those of us working in the fast-paced and hectic ED environment, but it’s important to remember that anything that’s worthwhile takes time. Mediocrity is often the result when things are done in haste; that which is worth doing at all is worth doing with time and consideration.

4. Plans are Made to be Broken.

Bumps in the road occur, and that’s OK. The real test will be to see how you react and recover from those inevitable bumps.

5. Don’t Worry, Be Happy

When you doubt your own ability, you are the only person standing in the way of your success. Self-doubt is very powerful, but it’s just a “feeling” that’s not based on any scientific facts or formulas. So silence any self-doubt you have before it consumes you. We are truly our toughest critics.

6. Set Goals Often.

If you want to succeed, you need to set goals. Without goals, you may lack focus and direction. If you set goals and have a plan for achieving them, it’ll be easier to correct any missteps along the way.

7. Happiness Takes Work.

Eleanor Roosevelt said, “Happiness is not a goal; it is a by-product,” and I have found this to be very true at work. If you demonstrate a great work ethic at a job you love, happiness will shine through in all you do.

8. Worry is Wasteful.

Worry about only the things that are in your control, the things that can be influenced and changed by your actions, not about the things that are beyond your capacity to direct or alter. This will save you many sleepless nights – and a few grey hairs, too.

9. No One Does Anything Alone.

True solo acts are rare. Most amazing feats in history were created and executed through the efforts of people who agreed to work together. So if you think that you can achieve all of your dreams on your own, you are mistaken. The more quickly you can admit that there will be a crowd of people cheering you on, opening doors, and working behind the scenes, the more quickly you will achieve success.

10. Passion Can Take You Where Talent Can’t.

I didn’t begin my scribe role as an outstanding talent among my peers, but I was passionate about doing the job well. I relied on my passion for hard work where my talent fell short, and this helped me tremendously. I’ve seen this to be the case as well with some of the best and brightest medical scribes that we’ve employed.

And let your passions lead you along some of those non-traditional paths; I still love to dance!

Kathleen Gardell is a Regional Manager for the Clinical Information Manager Department at Emergency Medical Associates, covering 10 emergency departments. She received a bachelor’s degree in nutritional sciences with a concentration in dietetics from Montclair (N.J.) State University. Prior to being promoted into her current role, Gardell was one of two medical scribes on Emergency Medical Associates’ CIM Staffing Support Team. She also has served as a medical scribe at Clara Maass Medical Center in Belleville, N.J., and Bayshore Community Hospital in Holmdel, N.J.

Quick Tips with Dr. Marc Milano

By Marc Milano, MD, FACEP78463787_15

Topic: Patient Satisfaction

As a physician in the ED you are in continual struggle to provide the finest care but deliver an expected level of efficiency. The clock is always ticking in the emergency department and every second you spend, or fail to spend, with the patient is counted toward their impression of you and your performance on the survey.

Patient satisfaction relies on many factors. Clear communication, compassion, and good medical practice form the cornerstones of success. Below are some helpful tricks to bend the perception of time, increase efficiency and give the patients what they want most – a physician’s attention.

Thin Slicing: One way of increasing patient satisfaction is by decreasing room-to-physician times.  A technique that can shorten the time to “first contact” is the thin slicing technique. Simply put, an introduction, followed by a brief, focused history and exam with the promise to return later allows you to see several patients in rapid succession. This way the next patient isn’t waiting for you to complete an extensive evaluation on the previous one. This works especially well if you have several patients to see at the beginning of your shift.

The Pit Stop: When seeing “new” patients, especially given the geography of a large ED, try to quickly stop by and catch up with “old” patients in the same area.  Simple, focused questions like, “How is your pain?” or “Are you doing OK, drinking the contrast for your CT?” will keep the interaction brief.  This saves time and can really score big in terms of patient satisfaction.  It lets patients know that you are on top of things and also gives you a chance to discover any issues or problems early on.

These are just a couple of examples of how simple techniques can have a significant effect on the patient experience–and maybe even make your shift go more quickly and smoothly!

Marc A. Milano, MD, FACEP, is chief of the department of emergency medicine at Bayshore Community Hospital in Holmdel, N.J.  He serves as physician head coach of the Patient Satisfaction Coaching Program at Emergency Medical Associates, an emergency medicine practice headquartered in Parsippany, N.J. Dr. Milano received his undergraduate degree from Rutgers University, his medical degree from St. George’s University in Grenada, and completed his emergency medicine residency at Newark Beth Israel Medical Center.

The Value of Emergency Medical Associates

By Shilpa Amin, MD, FACEP EMA_Eonly

When Emergency Medical Associates (EMA) is integrated into a hospital system, we ensure the highest standards of service on many different levels. EMA was founded in 1977 and has grown into a practice that’s taking the lead in various areas, including practice models, patient satisfaction, EMRs and using medical scribes. As a partner of the company, I’m proud that we’ve been named to Modern Healthcare’s Best Places to Work in Healthcare list for three years. In fact, EMA is the highest-ranking medical management company on the current list.

So how did we come so far? Below are my thoughts on how we accomplish the high goals set by the partnership.

Democratic Partnership: EMA is a rare practice in that it’s truly a physician-led and owned practice. Our physicians govern the company and set the goals yearly for the practice. All our partners have a voice and vote in the company. Our 97 percent retention rate speaks to how we create a culture where physicians can grow and find satisfaction throughout their EM careers. We have initiatives in place to help develop young leaders. We provide many opportunities for our partners to contribute to the company, whether it is a director of an ED, by joining a committee or even becoming a board member and helping run the business side of company. We are closely linked with the New Jersey chapter of the American College of Healthcare Executives (ACHENJ) and one of our corporate directors will assume the role of president of the chapter this spring.

Pioneering EMR and Scribes: EMA created a boutique electronic medical record, EDIMS, which stands for Emergency Department Information Management System. This program was created for and by practicing emergency medicine physicians, who worked along with a team of both IT and risk management contributors. This technology has allowed us to track and trend the patient data that we have collected over the years to develop research projects. Our practice also was among the first to use scribes in the ED.  Our comprehensive scribe training program enables scribes to work closely with providers to ensure timely reporting of labs and radiology reports and ensure efficient chart completion. Our scribes are an integral part of our team and help decrease length of stay in the emergency department.
Client Account Managers (CAMs): Each EMA site is assigned a client account manager to help with day-to-day operations in the ED. Our CAMs are former nursing or ED administrators who have a wealth of knowledge about increasing productivity and efficiency in the ED. They serve as key liaisons between our practice and the hospital.

Operational Metrics: At times it seems like we analyze everything! We have an amazing practice management team at our corporate headquarters that evaluates data and practices to find new ways to improve ED operations. We measure a variety of outcomes; including door-to-provider time, door-to-discharge time, and admission-order–to-floor time, just to name a few. We consistently review these metrics during our monthly business meetings to discuss ways to improve these times.

Observation Units: EMA works closely with hospital administration to improve patient throughput and patient satisfaction. At one site, the team noticed that patients were waiting in the ED for chest pain observation, abdominal pain radiologic and consultant evaluations and TIA neurological testing. Often, these patients occupied beds that could’ve been used for patients waiting to be seen in the ED waiting room. The medical director approached the hospital’s administration about creating an observation unit that would function as an extension of the ED. Our physicians would continue to care for these patients and would work closely with the medical staff to ensure proper testing and evaluation was conducted for the patients. Once evaluated, patients would be discharged or admitted from the observation unit. The hospital’s administration consented, and this observation unit continues to be one that other EDs use as a model.

Community Outreach: Our physicians consider themselves a part of the hospital, and by extension, a part of the community that the hospital serves.  Our clinicians contribute to hospital boards, committees and lectures. They participate in various hospital functions, such as fundraising events, galas and golf outings. Our physicians often speak to local and national news media. Many of our physicians take part in medical missions, most recently traveling to Haiti and Mexico. And, our partners participate in educational forums with local EMS, teaching EMTs about various disease processes and how to improve pre-hospital care.

Regional and National Chapter Involvement: All EMA physicians belong to ACEP, SAEM, AAEM or ACOEP . One of our partners, Michael Gerardi, MD, is the president-elect of ACEP. Our President and CEO, Ray Iannaccone, MD, was the Chairman of Democratic Group of ACEP. We truly understand the importance of these chapters and associations and their efforts to improve emergency medicine as a specialty. Our partners are involved in many committees and sit on various boards of these national groups.

Hospitalist Programs: Often times when the hospital administrators approach EMA to run the ED, we are tapped to provide additional services. Such was the development of our hospitalist and house physician program. EMA provides hospitalist services at six hospitals. The team approach of having the same company run the ED and hospitalist program has allowed for smoother transitions during admission and decreased length of stay in the ED.

After nearly 40 years in emergency medicine, our practice fully understands how an ED functions in relation to the rest of the hospital and the department’s importance within the community. Our physicians are committed to building long-standing relationships with each hospital and the communities that they serve. We have set the bar very high and expect only the best medical care from our team.

Shilpa Amin-Shah, MD, FACEP, is a full-time attending emergency physician at Saint Barnabas Medical Center in Livingston, N.J. Dr. Amin is also the Director of the Physician Recruiting Team with Emergency Medical Associates, Parsippany, N.J. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine and served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and two young children.

The Perks of Being an Urgent Care Physician

By Kurt Perry, MDIMG_3548

A short while ago, when I was working full-time in the emergency department of our local hospital, we would get those days when it seemed we just could not keep up with the flow of patients. In between evaluating a chest pain patient for a possible heart attack or a patient struggling to catch her breath, a chart would pop up in the queue for someone with a scratchy throat and cough or a rash that had been present for months. A collective sigh would go out with thoughts of: “Why is this an emergency?” or “Can’t people see that we’re busy caring for those whose lives are in danger?” Yes, we understand that you also don’t feel well, but can’t your primary care doctor take care of this problem?

Well, unfortunately the answer often is “no.” Either the patient has no private physician, or no insurance, or has called her primary care physician’s office and has been told that the doctor is booked and can’t see her until next week. All of which leads her to go to the place of last resort; the safety net of the American healthcare system, the place where no one is turned away, where everyone will be seen eventually, the emergency department.

Likewise, primary care physicians are increasingly busy caring for the chronic health problems of an aging population and have difficulty squeezing in even someone with a minor emergency. And with the Affordable Care Act (“Obamacare”) now in effect, the demand for primary care physicians is expected to increase dramatically as the previously uninsured receive coverage. And so it appears that a niche is developing in the healthcare industry to provide a place for the treatment of minor emergencies — the urgent care center. One need only look around at the number of these facilities starting up to see that there’s a demand for this type of service. And who better to staff these centers than emergency physicians?

The Advantages of a Career in Urgent Care

Unlike working in the emergency department where shifts vary day by day, working in an urgent care center allows for scheduling stability. Whether you are preparing for a family or for retirement, a career in urgent care can provide the stability your lifestyle requires.

While working as emergency physician, doctors are faced with new challenges every day. They work with patients of varying ages and ailments. Their need for change is constantly fulfilled. Urgent care can provide that same variety. From infants to teens to adults to seniors, working as an urgent care physician allows doctors to see a broad range of patients and treat a broad range of ailments from the common cold, broken bones and lacerations to performing physicals and administering vaccinations.

With urgent care centers gaining popularity, the need for physicians to staff the centers is increasing too. Steady hours, variety and more time to spend with patients make working as an urgent care physician a perfect choice for any physician. Keeping up on suturing skills, treating patients in a less stressful environment and developing a stronger bond with patients are just a few of the reasons emergency physicians enjoy working in the urgent care sector, and in our practice, Emergency Medical Associates, a portion of our partners take shifts at local urgent care centers. Some will decide to stay.

I loved working in the emergency department; it’s where I honed my practice and gained the knowledge and experience that shapes my practice today. But now as a full-time urgent care physician, I am equally challenged and fulfilled – but with better hours!

Kurt Perry, MD, joined Emergency Medical Associates in 1997. He is board-certified in emergency medicine and a 2013 New Jersey Monthly “Top Doctor.”  He completed his residency at Monmouth Medical Center, Long Branch, N.J.

Simple Tips for Staying Healthy in the Emergency Department

By Megan McGrane, PA picture for blog

We all know the basics of staying healthy while working, such as good hand washing and appropriate safety precautions. But sometimes while focusing on taking care of others, we forget to take care of ourselves. Here are a few super simple tips to staying healthy while working in the emergency department.

Don’t Forget to Eat

It can be difficult during a busy shift in the emergency department to find time to fit in a full meal. Often times we are so busy that we don’t have the chance to eat until we are ravenous and reaching for anything we see. Grabbing a quick snack out of the vending machine may be easy, but coming to work prepared with healthy options can help prevent the ravenous munchies and keep you on track and energized.
Healthy snacks, such as raw nuts or trail mix, an apple or banana with nut butter (like peanut butter or almond butter), or a quick snack like “roll ups” made of cold cuts, lettuce and cheese, can give you energy and keep you feeling full through your shift. These easy snacks also will help you avoid empty calories from candy and treats that will give you a sugar rush but leave you crashing later in the day.


Sometimes even mild dehydration can leave us feeling fatigued. Staying hydrated can play an important role in helping you feel energized on the job. Try “swapping out” your coffee or soda periodically; when you feel yourself reaching for a caffeinated drink, try downing a cool glass of water instead and watch as your energy bounces back.

Take a Walk

Taking a 20-minute walk outside is one of the best things you can do for your health, either before or after a shift. Getting sunshine and fresh air also is one of the best ways to help regulate your circadian rhythm when shifting between day and night. A brief walk can help ease stress, improve circulation and boost immunity. Easy, right?

Consider a Multivitamin

As medical professionals, we find vitamins and supplementation can be quite a hot button issue. Experts agree that if you are eating a balanced diet and are in generally good health, a multivitamin is unnecessary. However, when we really get honest with ourselves, how many of us sit down for “three square meals” filled with fresh fruit, veggies and lean protein during our shift work? Consider taking a high-quality multivitamin each day that includes vitamin D. During shiftwork, especially in the winter months, we may not get quality sunshine or eat the freshest high nutrient food as we do in warmer months.  A multivitamin can help fill in those nutritional gaps and keep us up and running.

Practice Stress Reduction Techniques

The emergency department can be a stressful place. Learning a few simple stress reduction techniques like deep breathing or even meditation can have an amazing impact on your health. Meditation can help you lower stress, lower blood pressure and sleep better. The simple technique of stepping aside or going to an empty room and taking 10 quiet, slow, deep breaths can help you reset your mindset in a moment while on the job. This simple act can improve your mental clarity while lowering your stress level.

In the emergency department, our focus is always on our patients. Their health is our primary concern. We skip eating, exercising and hydrating to provide them with exceptional care. Remembering to take care of ourselves first will help ensure a longer career of taking care of patients.

Megan McGrane is a full-time physician assistant at Saint Barnabas Medical Center in Livingston, N.J. She received a bachelor’s degree and a master’s degree in exercise physiology from the University of Pittsburgh and holds a second master’s degree from University of Medicine and Dentistry of New Jersey, Piscataway, N.J. She is a member of the American Academy of Physician Assistants.

7 Tips for Residents When Evaluating an Emergency Medicine Practice

By Shilpa Amin, MD, FACEP

Blue CheckmarksFall is here, and recruiting season is in full effect for graduating and, in some cases, junior residents. As you start your search for the perfect job in emergency medicine, keep in mind that one-third of you are likely to change jobs after your first year of practicing. That’s perfectly fine, because in most locations there are more jobs than there are available EM doctors.

As the director of our physician recruiting team, I have met hundreds of residents, and it seems that most of you have the same concerns. Just in time for ACEP’s Scientific Assembly, I’ve created the following questions and tips to help ensure that your interviews go smoothly, and, if you’re presented with an offer or two, that you compare the offers equally.

  1. LOCATION, LOCATION, LOCATION! Where do you want to be? If you can’t find a full-time job in the exact ED you want to be in, try working at two or three hospitals in that region until a full-time position opens. This will enable you to work in different practice settings and help you determine your true fit. Maybe you thought you really wanted to be in the busy trauma center because that’s what you’re used to from your residency training, but after working in a community hospital, you may find more professional satisfaction in that environment.
  2. YOUR PRACTICE: What type of practice setting do you want? There are several different types, from hospital employee to democratic group to independent contractor. You should evaluate each practice type from a personal and financial standpoint. You really need to understand this aspect clearly as it may frame the rest of your career.
  3. CAREER: What are your aspirations? Do you want to work in an environment that promotes advancement in your career or do you want to be able to just complete your shifts and go home? It’s a personal choice and you don’t have to make the decision right now. You need to know what your options are. If you are in interested in an administrative career, you should ask about these types of opportunities when you go on your interview. Additionally, ask about the opportunity for mentorship.
  4. SCHEDULE and VACATION: Be sure to ask what the required hours per year are to be considered full time. Ask if there’s a part-time option or track. Ask how the hours per year really work: Are you required to complete a certain number of hours per month? How does vacation work? Is there online web-based scheduling? Find out if because you’re the new kid on the block, that you’ll be working a disproportionate number of nights, weekends and holidays. You should ask to see a copy of the schedule when you go on your interview.
  5. QUALITY OF SHIFT: What tools are available to help you when you are working? Will associate practitioners work alongside you to help close that complicated laceration so you can keep the ED moving? Does the ED have scribes and an EMR? Can you complete your charts from home? Do you have access to support staff who can help you attain your medical license and get you on staff at the hospital?
  6. SALARY AND BENEFITS: You need to review this in detail. How is your pay determined? Is it a flat hourly or based on some measure of productivity? How is professional liability insurance provided? Is the tail included? Ask about retirement and 401(k) accounts. Is there a financial advisor available to talk to if you have questions?
  7. TEAMWORK: As an ED physician you are used to leading a team of residents, nurses, PAs, techs, etc. Your team when you are an attending physician is very important. When you go on your interviews, make time for a shadow shift. Take time to talk to the other physicians, APs and nurses. Note how they work together when a critically ill patient is in the ED. You want to be comfortable signing out a patient and feel confident that they’ll receive the same meticulous care you would have provided. Ask about the ED relationship with the hospital attending staff. What specialties are represented? Are they responsive to the ED?

Meet Dr. Amin Shah and other contributors to this blog at Booth 1333 at the 2013 ACEP Scientific Assembly in Seattle!

Shilpa Amin-Shah, MD, FACEP, is a full-time attending emergency physician at Saint Barnabas Medical Center in Livingston, N.J. Dr. Amin is also the Director of the Physician Recruiting Team with Emergency Medical Associates, Parsippany, N.J. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine and served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and two young children.


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