In addition to working the night shift in hospital emergency departments across the country for the past 20 years, Dr. Plaster has also served two tours in Iraq with the U.S. Navy and found time to write about his experiences. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and author of the 2013 book of short stories, “Night Shift: Stories from the Life of an ER Doc.”
Question: Of all the specialties, what drew you to emergency medicine? 
Dr. Mark Plaster: That’s a good question. I’m 62 years old, so I’m of the generation that emergency medicine was born out of. Back in the late 60s, when the American College of Emergency Physicians was forming, it just seemed like a lot of fun.
I’m kind of an adrenaline junkie, and the idea of seeing a different kind of patient every few minutes, with life or death [circumstances], appealed to me. It just captured my imagination. I knew it’d be difficult and an intellectual challenge my entire career. It never dawned on me I’d work nights and holidays, but the notion of standing in the gap of an emergency was thrilling and inspiring. Frankly, I’ve never regretted it.
Emergency medicine fit right into my personality. Emergency physicians have, almost by nature, short attention spans and are drawn to multitasking. Some surgeons can do a procedure for eight hours. Most ER physicians would struggle with that type of focus. Most ER docs also tend to be more of mavericks, or at least we see ourselves that way.
Q: What are some disconnects you’ve encountered between hospital ERs and hospital administration? What do you wish those in the C-suite knew?
MP: Only in recent years have hospital administrators seen an incredibly well-functioning ER as a benefit to their hospital. I’ve been in this [field] for 30 years, and for first 20, I was looked at as a necessary evil. The ED was [for] patients the hospital didn’t really want but had to have. The medical staff was always the home team and [ER staff] were the visitors.
Over the last 10 years, as data started to emerge on the importance of the ED to a hospital’s financial survival, we finally got the attention I think we could have had 20, 30 years ago. Administrators years ago could have seen the ED as a vital part of their success and put money, time and expertise into it. We’d be light years ahead of where we are now. They are starting to recognize it, but only after we had huge issues to deal with, like crowding and patient holding.
Emergency department crowding and holding just exploded as a problem. In the last 20 years, it used to be that about 20 percent of hospital admissions came through ED. More recently, the ED benchmarking alliance data from 2012 indicates that upwards of 60 percent of admissions come from ED. What’s happening is the processes for getting them from ED into the hospital have never been looked at hard. And as result, you build up huge backlogs — it’s all over the country — and it’s not uncommon to see patients wait up to 10 hours in the ER after the decision has made to admit them.
If hospitals looked at the ED and admitting process, and realized just how important it was and devote time and attention to make that process smooth and painless for patients and families, you’d find that physicians would practice in that hospital preferentially because their admissions would be smooth. The quality of the physicians in the department would be reliable.
Q: What are your thoughts on people who visit the ER instead of urgent care settings or retail clinics, or people who visit the ER frequently?
MP: For one thing, the impact of frequent fliers on the ED is overstated in my opinion. They make for great stories, and we all talk about the guy who visits three times a day. But they don’t have a huge impact on overall flow of an ED. As far as unnecessary cost points, some of the recent movements to giving specific patients a point of contact — someone who is making sure they are staying healthy — I personally think that is a good idea.
When I was first intern, we had a “frequent flier” who would come into ED, spend days in ICU and then go home only to return two weeks later. One of the jokes at the time was that if we had paid a nurse to make sure this guy stayed healthy, we would have saved money. There’s a certain pool of patients who use so much in healthcare assets that if we’d get them into closer outpatient follow-up — not let them fall through the cracks — they and the system would do better. They don’t have an overall impact [on the ED], but individually we could do them a lot better.
Q: What are some other healthcare issues you consider most pressing to ER physicians right now?
MP: Well, there’s a lot of talk about trying to divert patients from the ED to a medical home or primary care or variety of other [places]. I think the public, the news and lawmakers miss the point. The point is that people show up to the ED because they’re sick and want to be cared for now, while they’re sick.
What people fail to understand with medical homes is the only way that works is if the family doc is available 24 hours a day, seven days a week. Otherwise [the ED becomes] the medical home after the office closes. Even if they go to an on-call doc, that’s not different than what an ED does. How different is that from coming to the ED and having a physician start from scratch? The real issue is medical records. What that on-call doc needs is same thing I need in the ED. Emergency medicine with right access to medical records is superior to the medical home, and that’s what people don’t understand.
Q: As someone who spent 20 years working at night, can you share any advice or tips you might have for physicians who are feeling burnt out?
MP: I think burn out is not a professional issue, it’s an emotional issue. If you go to work every day and realize you’ve done something important — that you’ve saved lives and played important part in grand scheme of life — you come home physically tired but emotionally uplifted, even if it’s been a hard day. I think burnout comes from when we fail to see, from emotional and spiritual standpoints, the importance of what we do.
You can become physically burnt out, and that happens. [You are] exhausted after night shifts. Or you can become emotionally exhausted when administration isn’t supportive or if you’ve been sued. In those situations, you might have to find a different setting — a different hospital or an urgent care [setting] where you’re not working at night. But a fundamental antidote to burnout is to recognize the significance of what you do. You have to find meaning in what you do. [Once you do,] it’s surprising how other things fall into line.
More Articles on Hospital Emergency Departments:
The Emergency Department: The Nexus of Healthcare
The Emergency Department is Overflowing With Opportunity
6 Recent Studies on Emergency Department Visits
