As I approached residency graduation, like many new physicians before me, I was scared. During residency I had been surrounded by mentors – people guiding my personal growth and development, and I was scared that on my own, that growth would stop.
When I was a resident, from day one people around me were there to be valuable resources and support my success. Within a month of becoming a resident I was paired up with an attending mentor that basically coached me into becoming a better resident, and helped me with my research endeavors. That relationship made my residency the optimal place and time for me to learn how to be a qualified, experienced, and above all compassionate attending.
When I finally graduated, I expected to be thrown to the wolves. One month before orientation at my new company, I had a nightmare: I walk into the department and an over-worked-very-angry charge nurse pushes me into a room where I find not one, but two pediatric patients with congenital airway defects, related to an important politician, in cardiac arrest. I woke up in a sweat. The day before orientation, I made sure to bring my PALS card – just in case.
When orientation day began I was greeted not by clinical staff, but by the senior leadership at my company, US Acute Care Solutions. The President for my region, Dr. Angelo Falcone, told us his personal story – and the history of USACS – with one theme: “As a provider here, you’re never alone.”
The Chief Quality Officer, Jim McQuiston, met with everyone and gave some tips on documenting properly and the USACS way of providing safe, quality care. One particularly nice part of orientation gave me a chance to meet some of the other providers at Meritus Medical Center, where I would be working, including two people that would eventually be very important in my career. One was Steve Kotch, my medical director, and the other was a doctor who had gone to the same residency program as me and graduated a few years before. They both told me that if I ever had any questions they would be there to answer them. It was simple, but extremely reassuring.
The next day, Josh Muyderman, the doctor who had been in my residency program, called me. My first shift was still nearly two weeks away, and he wanted to grab a few beers. Josh gave me the run-down on the entire campus. He explained the ins and outs of the organization and gave me an idea of what to expect on my first day. Most importantly, he told me exactly what my resources were should a crashing pediatric patient come rolling through the ambulance bay. He told me that at every provider gets assigned a mentor – and he would be mine.
On shift number one Josh was right there with me – making sure I wasn’t sending anyone home to die or mis-ordering a VQ scan. My first couple shifts, I was essentially an “extra provider,” meaning there was no pressure for me to see every patient walking in. Josh introduced me to every single nurse, and made sure that I knew which ones might be a little more edgy (but always exceptional).
I completed my first day exhausted, but comfortable that I knew the basics of how the department worked. Steve Kotch, my medical director, stopped by to check in and make sure nothing was throwing me off. Shift one: no coding kids, no violently mean nurses, no blatant mis-ordering of tests. I’d say it was a win.
About three months in, I started to get a little restless. There was a part of the Emergency Department that I felt could use a little improvement. Our sepsis protocol was outdated and still not up to date with current literature and current practice guidelines. I told Josh, who passed it along to Steve.
Soon after Steve pulled me aside and asked if I wanted to take on the Sepsis project. What really stuck with me, was what he said: “There’s no rush. Once you feel comfortable clinically, we can start working on projects, but if you’re ready, here’s how we can start.” He reminded me that first and foremost my job was to be a strong clinician, and after that he gave me the tools to engage the staff and begin my project. He had some people from other campuses contact me. Before I knew it, I was putting together our sepsis protocol with the aid of people from other nearby sites.
Steve and Josh kept on meeting with me to help guide me in coming up with my sepsis protocol and getting buy-in from the rest of our providers. As I moved through the different stages of planning, Steve suggested that I link up with Jim McQuiston. Jim was our Chief Quality Officer and had similar clinical interests to mine. After six months, I felt comfortable clinically, and was beginning my foray into leadership and guidance with the aid of Josh, Steve, and now Jim.
When I met with Jim what struck me immediately was his candor about leadership. He stressed the importance of consensus, of results, or going slowly. I vividly remember him telling me: “I know you want to finish your project tomorrow, but things that are built slowly, last longer.”
Jim directed me toward a few books and things I could practice to be a more effective leader – books by Dale Carnegie, Steven Covey, Marshall Goldsmith. Being used to reading, I devoured the books, and took his principles to heart. A few months later, we had our sepsis go-live date, and it was easy, adopted by most our providers, and bought into by our nursing staff – a success right from the start. To this day, people still chant our comedic sepsis logo “Sepsis is Serious.”
Months passed, and sepsis stayed serious, only our metrics for mortality, door-to-antibiotics, and early detection all improved. The providers, nurses, and techs were all able to make a real difference because they bought in to what we were doing. That buy-in certainly wouldn’t have been possible without the guidance of Steve and Jim.
As my first year came to a close, I met up with Steve and Jim and reviewed my progress. Things were looking good, my clinical performance was sound, our project went well, and I had grown as a leader by implementing the lessons I’d learned from the books I’d read. At the end of that meeting, Jim suggested that I apply for the Assistant Medical Director position at Meritus. The spot was opening up, and while there were a number of very qualified candidates, he said the application process would be good for me.
I interviewed for the position and was greeted by a panel of USACS staff (both local and from our Germantown office), and my medical director, Steve. They asked very specific questions about my motivation, my past experiences, my sepsis project, my successes and failures. They said their goal was to find the person that was not only qualified for the job, but motivated for the right reasons. I’m a fairly simple person, and my reasons were just as simple. I believe without any question that Meritus is the best campus, and as a team we can continue to improve and be a strong department.
The next week, Steve called me – I had gotten the position.
Now as Assistant Medical Director, I felt like I was starting my job all over again. I didn’t know what was expected or what I should be doing. However, this time, I wasn’t that worried, as I had Josh, Steve and Jim in the corner basically giving me tips and telling me what my next steps should be. I was given a few more books and put into USACS’ Leadership Academy. The academy had about a dozen other people from all across the company that had a similar need – education.
We had monthly classes, a quarterly coach, and discussed every problem or issue we were having as a department. The things I learned were simple, like how to conduct effective meetings, how to communicate effectively to a group of different people, and how to interact with different personalities.
These were avenues of education I didn’t even know existed, yet after learning about them, my entire interaction style changed. The “go-go-go, get it solved” mentality I had as a resident was replaced by a “let’s listen, get everyone’s opinion, and act slowly” approach. The latter approach garnered enthusiasm from the providers, nursing, tech, and support staff.
Now, in my new role, I felt comfortable that whatever challenge came up, I would have Jim, Steve, and my entire Leadership Academy team available to answer questions. Working together, with the aid of our USACS resources, the Meritus campus has done a lot – from patient satisfaction, to readmission reduction, to provider in triage. It’s been a very good year and I look forward to having many more.
Looking back over my first years at USACS, I realize that my initial fears were completely unnecessary – mentors have surrounded me since day one. From Josh, to Steve, to Jim, these are people that have guided my growth and development and continue to do so today. I can say without question that I’ve grown more during the past few years as an attending, than in the three before as a resident. It wasn’t any one aspect that fostered my growth – it was the combination of people, classes, books, and experience. Its taken a lot of time, but I know – “things built slowly, last longer.”