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The ACEP and RAND Study

Interview with David Schriger, Peter Viccellio, and Al Sacchetti, MD's

Four decades of emergency medicine experience reveals how the specialty continues to normalize dysfunction while failing to articulate what emergency care should look like. Veterans explore solutions to the systemic problems that have kept emergency departments "at the breaking point" for over 30 years.

• Emergency physician compensation ranks around 16th among medical specialties—not the financial crisis some portray
• Working conditions, not compensation, represent the true crisis in emergency medicine today
• Emergency departments generate 33-50% of hospital revenue, but this value is rarely recognized by administration
• Physicians have accepted and normalized dysfunctional practices like hallway medicine instead of demanding change
• Simple solutions like elective scheduling smoothing and enhanced discharge programs work but aren't widely adopted
• Emergency medicine needs to define and demand what optimal practice should look like
• The healthcare system tries to solve 7-day-a-week problems with 5-day-a-week solutions
• Hospitals contain chaos in emergency departments to maintain predictability on inpatient floors
• Emergency physicians increasingly moving into hospital leadership roles where they can implement systemic improvements

Listen to our next episode where we'll explore how new emergency physicians can advocate for better workplace conditions despite institutional resistance.

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The Dr. Lorna Breen Heroes Foundation works to eliminate barriers to mental health access and improve work environments for healthcare workers, following the tragic suicide of Dr. Lorna Breen during the first COVID wave.

A interview with CEO Stephanie Simmons

Links:

ALL IN for Mental Health: https://drlornabreen.org/allinformentalhealth/

Specifically the ALL IN for Mental Health resource page: https://drlornabreen.org/allinformentalhealth/six-actions/accessible-affordable-mental-health-care/

ACEP wellbeing resource page: https://www.acep.org/life-as-a-physician/wellness

Dr. Lorna Breen Heroes' Foundation Licensing/Credentialing toolkit: https://drlornabreen.org/removebarriers/

Write your Representative to support Reauthorization of the Dr. Lorna Breen Healthcare Provider Protection act: https://drlornabreen.org/reauthorizelba/

Become an Ambassador: https://drlornabreen.org/become-an-ambassador/

Donate (and thank you!): https://drlornabreen.org/donate/

Summary:
• Founded by Lorna's sister and brother-in-law after thousands of healthcare workers reached out following her death
• Three main areas of work: advocacy at federal and state levels, advanced collaboration, and accelerating solutions
• Successfully helped pass the Dr. Lorna Breen Health Care Provider Protection Act in 2022, establishing grants for healthcare provider mental health programs
• Working to remove stigmatizing questions about mental health from licensing and credentialing applications
• 35 state medical boards and over 600 hospitals have removed invasive mental health questions
• Many healthcare workers avoid seeking mental health care fearing professional consequences
• Anonymous resources available include the Emotional PPE Project and Physician Support Line
• Healthcare workers compartmentalize trauma like "putting it in a backpack" that eventually becomes too heavy
• The foundation is committed to being "completionist" in changing all state licensing boards
• Physicians and healthcare workers have unique power to advocate for these changes

Visit the All In for Mental Health website for resources and use the legislative call to action tool to support reauthorization of the Dr. Lorna Breen Healthcare Provider Protection Act.

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The Nocturnists Podcast with Emily Silverman, MD

The HBO Max series "The Pit" has struck a chord with healthcare professionals unlike any medical drama before it. What makes this show so different? Why are doctors and nurses messaging each other saying, "You have to watch this—they finally got it right"?

In this special bonus episode, I sit down with the brilliant creative team behind the show that's capturing the true essence of emergency medicine: R. Scott Gemmel (creator and showrunner), Joe Sachs (emergency physician and writer), and Mel Herbert (renowned ER educator and consultant).

Our conversation reveals how "The Pit" breaks new ground through its revolutionary real-time storytelling format—each episode covers just one hour of a 15-hour shift, immersing viewers in the relentless pace experienced by healthcare workers. We explore how the team meticulously crafts authentic medical scenarios, using actual cases as jumping-off points for character development while ensuring perfect technical accuracy.

The show's commitment to authenticity extends beyond medicine to address systemic healthcare challenges—the boarding crisis, corporate pressure over satisfaction scores, staff shortages, and the alarming rise in violence against healthcare workers. As Joe reveals, "56% of nurses reported experiencing physical assault in the last month." By tackling these realities head-on, "The Pit" serves as both entertainment and powerful advocacy.

We also get fascinating behind-the-scenes insights into the production process, from the incredibly detailed set design (complete with sometimes-too-convincing fake toilets) to the custom-built anatomical models created for intubation scenes. The team's dedication to getting every detail right explains why healthcare workers are feeling so seen by this groundbreaking show.

The conversation concludes on a hopeful note as the creators share their ultimate mission—to celebrate the extraordinary dedication of emergency medicine professionals while inspiring a new generation to enter healthcare despite today's challenges. As Scott beautifully puts it, the show is fundamentally "a love letter to a profession that is sometimes just taken for granted."

Listen now to discover how storytelling can bridge the gap between healthcare realities and public understanding in ways that might just change how we all see the emergency department and those who work there.

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Link to scott course: https://guidewirecoaching.com/unburnable/

Scott Weingart shares his experiences developing physician executive coaching to help emergency physicians find meaning and purpose despite a broken healthcare system.

• Burnout often stems from negative inner voice rather than external circumstances
• Cognitive distancing helps physicians separate themselves from unhelpful thoughts
• Stoic acceptance allows doctors to focus energy on what they can control
• Nonviolent communication techniques transform interactions with difficult consultants
• Maintaining fundamentals during shifts (eating, drinking, bathroom breaks) is essential
• Optimal performance pace prioritizes patient safety and career longevity
• Sleep optimization receives special focus, with warnings about alcohol and caffeine
• Lifelong learning reignites the curiosity and satisfaction many found in residency
• Executive coaching costs approximately $3,000 for twelve sessions over 24 weeks
• Regular meditation practice can be transformative for emergency physicians
• Every emergency physician should consider therapy from the beginning of their career

Call us or visit our website to learn more about physician executive coaching and register for upcoming sessions.

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We're exploring the integration of AI search within Corpendium and discussing the delicate balance between powerful search capabilities and maintaining medical accuracy. Our team dives deep into the technical challenges and ethical considerations of implementing AI in a trusted medical reference platform.

• AI search struggles with staying confined to just Corpendium's content despite explicit instructions
• RAG (Retrieval Augmented Generation) allows AI to search internal databases while maintaining natural language understanding
• The tension between sensitivity and specificity mirrors clinical decision-making in emergency medicine
• Vector space embeddings help AI understand semantic relationships between medical terms beyond simple keyword matching
• Citations and references are crucial for verifying AI-generated information against human-authored content
• Traditional search still has value, especially in offline modes where large language models aren't available
• Expert human judgment remains essential as AI can make dangerous mistakes despite sounding authoritative
• Editorial teams benefit from AI by automating formatting tasks while focusing human expertise on clinical content
• The system will launch in beta with user feedback mechanisms to continuously improve accuracy
• AI is most valuable as a tool for experts rather than a replacement for medical education and training

AI doesn't replace the learning that medical professionals go through. It's exceptionally helpful in the hands of experts, but always scrutinize what it tells you.

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Mel will be on a trip to Kenya doing some teaching. Show will reboot in mid March. Lts of great interviews coming up!

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Mel interviews Graham Walk of "MD Calc" fame. This episode explores the evolving role of AI in healthcare, focusing on a study that compares ChatGPT's performance to that of human doctors in managing complex medical cases. We discuss the implications of these findings, the potential for misinformation, and the future of AI integration in clinical practice.

• Examination of the BMJ study on AI vs. doctors
• Real-world application of AI in patient care
• Concerns around AI misdiagnosis and misinformation
• Future prospects of AI in healthcare settings
• Impacts of AI integration on workforce and private equity
• Human-AI collaboration as a path forward

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