The Story of MEP Book Excerpt: Dr. Jesse Irwin

Editor’s note: the following is an excerpt from a book of stories from USACS founding partner MEP Health. The book chronicles stories about their providers’ lives, values, motivations, and career paths. MEP Health joined USACS in December 2015.

Four years of med school, five years in the Navy, and three at residency at George Washington—and I still couldn’t make an excel spreadsheet to save my life. I also really didn’t want to ask my MBA wife for help, so I tore out a piece of notebook paper and did what many new emergency physicians do: I drew out a pluses and minuses diagram to decide which job offer to take. 

Years later I still think about this moment and the day that led up to it. I remember the feeling of being unsure about what direction to take during a very unfamiliar period of my life. Later, when I became MEP’s head of recruiting, with no previous HR or recruiting experience, I knew that at least I would be able to relate my experience to the new docs who were going through the same thing.

There are some people who have always known what they wanted to do with their life. They are born to drive a race car or be an entrepreneur—and anything that doesn’t lead them toward that goal counts as a distraction. That wasn’t me.

No one in my family was in healthcare. In school I liked to play sports. My dad was a CPA and owned his own business. I got into Duke off the waitlist. I majored in biology, but I certainly wasn’t part of the club that was clearly on route to medical school.

Still, my vision of being a doctor was that it was the sort of profession that was a high bar to reach. A tough goal. A solid achievement. Being a doctor appealed to me because of all the things its title implied: seriousness, prestige, intelligence. My dad used to say I had a “silent ego,” someone who’s very motivated but who doesn’t wear that on his sleeve. It’s a fitting description to this day.

At Duke, there was the pre-med crowd, and then there was me. I got good grades and did well on the MCATs, but I didn’t play the pre-med game. They were the ones who volunteered at the local children’s hospital, who regularly met with their pre-med counselor for advice, who had their eyes narrowly set on that one goal above all else. I was enjoying being an undergrad.

I did not have a master plan. In College I spent six months in Australia, where supposedly I was studying marine biology, but really I was surfing and gaining weight. When I applied to medical school, ER was the number one show on TV, and it was a high point for applications to go be a doctor. I didn’t get in.

What could have been a low point turned out to be a blessing. I moved to Park City, Utah, where I skied a lot, worked at a resort for millionaires, and met my wife. The place I worked was called The Stag Lodge. I was a concierge. It remains one of my favorite places on earth.

The job may have seemed frivolous at the time, but the year off from school made all the difference in the world. My dad, he said, “You can be a doctor for 39 years instead of 40 years,” words I think about every time something doesn’t go just how I want it the first time around.

When I got to medical school in 1997 I was more focused than ever. My folks had supported me financially for my undergraduate studies, but med school was on me, so I found and signed up for a Navy scholarship. You sign up, you raise your right hand, and the Navy commissions you as an ensign in the inactive reserve for as long as it takes to go through medical school. When you’re done, you’re an active duty lieutenant and you owe the Navy five years of service.

I came on active duty in June 2001. I was doing an anesthesia rotation at Portsmouth Naval Hospital when 9-11 happened. All of a sudden my boring and predictable “Cold War” naval experience turned into active deployment on a warship to the Persian Gulf. I was deployed in 2002 aboard the USS Kearsarge, along with the crew and 3,000 marines en route to the Middle East, spending the better part of the next three years patrolling the Gulf while we fought the Iraq War.

In theory we were supposed to be a receiving ship for casualties, but in practice it was more like being an ER doc for a small town of 1,200 people. We didn’t, in the end, receive many casualties of war. Instead I dealt with psychological issues, orthopedic injuries, and other random problems.

I’ve never been in that much of a hurry for the next part of life, so when my time was up I actually considered staying in the Navy. There are some people who feel that any life experience in between now and their goal is a distraction. They want to become a neurosurgeon, for example, and any experience that doesn’t take them in that direction is just one more day they weren’t a neurosurgeon.

That just wasn’t me. I didn’t necessarily love the Navy, but I loved the people I met, the spirit of service, and the idea of being part of something bigger than myself. Still, I decided to move on. My wife and I moved to Washington DC, where she was from, and I attended residency at George Washington University. We had two kids, my wife started her business, and before long it was time to start my job search.

I scheduled my first interview at Shady Grove Adventist Hospital in Rockville as a practice interview. The hospital was outside the Beltway, which made it seem too far from DC to be a good option. But when I got there in 25 minutes from our house in Georgetown I realized it actually wasn’t as far as I’d thought.

To this day I remember pulling into that hospital parking lot. I was wearing a brand new suit and it was 90 degrees out. I checked my tie in the car mirror. My collar was tight around my neck; I even had cufflinks. The whole thing didn’t quite fit me, and I must’ve looked just as uncomfortable as I felt.

My first job interview, for the millionaire’s lodge in Park City, had literally been conducted over shots of sake. Now, I walked into the hospital to meet with the medical director, Dr. Brett Gamma. I wanted to impress him obviously, and I was nervous for my first post-residency interview. The interview was a tiny, cramped conference room, and I honestly didn’t know how I was doing, even by the end.

But one thing I knew: I liked Dr. Gamma. He wore his heart on his sleeve, and more importantly he seemed like someone who I could trust. We are colleagues to this day, and my first impression of him has proven correct.

I did interview with a number of other programs, and in the end it came down to MEP and one other company. That’s when I took out the loose-leaf paper from a notebook and wrote out the pluses and minuses diagram. The top line, as it is for many new ER docs, is hourly salary. That seemed like the easiest way to compare apples to apples, even though it was far from the determining factor for me.

MEP had the other company beat on salary, but in many ways the two seemed roughly equal. In some ways it felt like I was choosing among equals, so I went with the place where I felt most connected. That was MEP. The other company was recruiting me with a professional recruiter who hadn’t called me back when I wanted to ask questions. With MEP, I’d mainly interacted with other physicians during the process, and they were people I liked, who I felt I could work with, who seemed like they would do what they said.

To seal the deal I again decided to test out how far the hospital was from my house. So I took my 15-month-old daughter in the car with me to make the drive one more time. I knew with her in the back seat I wouldn’t speed in some semi-conscious effort to prove to myself that the hospital was close enough to the city. It still ended up taking 25 minutes. I was sold.

During the interview I’d been nervous about a variety of things, but one thing I was particularly apprehensive to bring up was the fact that I wasn’t actually in a rush to jump into anything beyond simply practicing medicine. As I told Dr. Gamma, I’d been captain of everything my entire life: captain of my soccer, baseball, and basketball teams, a leader in the military, Chief Resident during my residency. I also had two young kids. Now was the time to restore some balance in my life.

It was a scary time. My first months as a new physician were a blur. I’m sure I was nervous, overwhelmed, and scared I was going to hurt somebody, or perhaps that I’d look stupid in the eyes of one of my new colleagues. I remember I gave tPA for the first time without a neurologist at the bedside. Twice actually. It scared the hell out of me. But both patients got better, and so did I.

What I do remember vividly is the drive to work during those first couple of months. Especially on the night shifts, where felt like I was fighting the good fight alone, while the rest of the normal world was fast asleep. I remember feeling terribly alone, although I wasn’t of course. I had a full cadre of nurses and techs with many more years of experience in the ED than I did.

Still, it wasn’t long before I was ready to take on a new challenge. I’d led a small quality initiative at the behest of Dr. David Klein, MEP’s president. Then Dr. Aaron Snyder asked if I wanted to work on physician recruiting. It was an area that was utterly foreign to me. I’d never even thought about human resources issues, much less had any experience with them.

On the other hand, maybe those were reasons that I might be right for the job. I’m not a natural salesman, and I lack all capacity to lie or mislead. That’s just the truth. My wife knows it and I know it. And I think ultimately that’s what new physicians are looking for when they’re looking for a job—that same honest connection I felt when I first interviewed. That was an experience and an approach I could bring to the job. I know that at the end of the day the job hunt can turn into a little bit of alphabet soup. It certainly doesn’t help that names of all the emergency medicine companies all sound the same. On top of that, new physicians are often afraid to ask the kinds of questions during the job interview that might help them develop the trust and connection they need. Maybe because they’re afraid of sounding naive or unprepared. Believe me, I know.

Whatever my reservations about taking on the recruiting job, I knew that at least I would be able to share my experience with people. I would also be able to shape the group of people who would be my colleagues, both at my campus and throughout the company. There are many times since when I’ve reminded Dr. Snyder that I didn’t actually interview for the MEP Recruiting job. In some ways choosing to become an emergency physician is primarily a lifestyle decision. We get fixed hours, we don’t have to take our work home with us, and when you’re off, you’re off. Yet here I was taking on a job that kept me working far outside of my shifts at the hospital. Sometimes I wonder, “How the heck did this happen?” I certainly didn’t go into emergency medicine to become the head of recruiting.

But at the same time the conversations I’ve had with people who are residents in the same position I was, who were nervous, who were looking for honest answers to alleviate their fears, have made the job well worth it. I always tell people who I interview: “There’s a good reason MEP has me doing this. Clearly, I’m drinking the koolaid, but the last thing I want you to do is come to our company only to find out you were misled. That doesn’t do anyone any good.”

You certainly can’t pretend to be something you’re not in this job— that gets found out pretty quickly. After more than five years working here, I feel like I can trust people’s word, and that what people told me would happen when I interviewed has happened. If there’s a value in what I’ve been able to do here, it’s found through honesty in communicating what it’s like here to our prospective recruits. Truly, I am a poor liar. And that makes me a good fit for this job and this company.