On January of this year, I worked my last clinical shift in an ER. I realized recently that it’s been ten months since I cared for a patient at a bedside. The question some would ask is this: why, after 25 years of doing this, did I stop? Do I still miss it? Will I ever go back?

All good questions and ones each of us will need to answer for ourselves. At some point all of us who practice emergency medicine will stop seeing patients clinically. Some will do it after a long and successful career. Some will do it after a few years as a change to something different. Some will stop due to burnout. Others because it is just time. I know for me that the time came and I made the decision. It’s different for everyone, as it should be.

So, why did I make this decision? Currently I help support almost 70 sites in eight states. Over time, I found myself on the road almost weekly traveling to sites, meeting with our teams, senior leadership at hospitals, and new groups interested in joining US Acute Care Solutions.

I’ve come to see my role as determining where there is need for support from the larger organization, prioritizing that need and advocating to make it happen. Whether that’s making sure a particular health system knows how our on-site patient experience program can help get the entire ED team on the same page, or helping to coordinate our powerful technology resources to show a hospital client how we benchmark internally and with the industry, my job is to connect the pieces to make it happen.

As I traveled throughout the region, I found time to squeeze in my clinical shifts on Fridays and Saturdays. After a while, however, I had to make a decision we all have to make, about the right balance for me and where am could provide the biggest value to the people I serve. More importantly, I had to decide what the right balance was for my family.

I will say, I love my job. I enjoy trying to solve complex problems and support my colleagues to treat thousands of patients every day. One of the most complex of those problems is how we continue to manage our individual sites where volume is falling, while continuing to focus on how to bring new opportunities like tele-health or remote triage, while also delivering information to each location to help them plan staffing most effectively.

We have a great regional leadership team and they deserve my time and commitment to succeed. I speak to every VP every week reviewing nearly every site, discussing where there are needs and successes. One question I ask in nearly every one of my one-on-ones is, “Who do I need to recognize this week?” We do amazing work every day and we need to shine a spotlight on that work. The VPs in turn speak with our Medical Directors almost every week and work with them to define needs, new opportunities and celebrate successes.

Most days are not easy. There is no shortage of challenges. What grounds me is the belief that we are doing good work and living our mission to serve and care for our patients. When I see the progress we have made in the last few years, I am justifiably proud of what we are collectively building.

Do I miss seeing patients at the bedside? The answer is yes. The best part of the job for me was always that moment I walked into a room, introduced myself, and let that patient know I was there to help and gain their trust over a manner of a few moments. We all have stories to tell about great saves, challenging cases and the occasional letter of gratitude you get from a patient. I will always miss those.

Will I ever go back? That’s a really hard question, as we all know practicing emergency medicine (or any form of medicine) is not like riding a bike. While I’ll never say never, I will say things would have to be very different to safely go back to practice.

In the end, each one of us will make this decision, either intentionally or have it made for us. When that time comes for you I hope you can look back with pride on your clinical time and anticipation of what lays before you. I certainly do.