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“Life is not a journey to the grave with the intention to arrive safely in a well-preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming, ‘WOW—What a ride!!’”

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Anonymous

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Growing up on the farm in Northern Minnesota required participating in a diversity of activities with my Dad, he would proffer that he was a “Jack of all trades and a master of none”. Well it was not strictly true as he was a Jack of all and a master of many. As a young farm boy one could not imagine someday participating in the inception and maturation of a specialty in which emergency physicians are, or have the training and skills to truly become a “Jack of all trades” and master of many.

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I describe herein some of the career steps from which you may gather an idea about expansion beyond your emergency department (ED), taking advantage of the broad-based training and skills that are unique to emergency medicine (EM).

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Times have changed a bit since my first ED shift in July of 1971, having just returned from Vietnam to Naval Hospital, San Diego. A moonlighting radiology resident could not make his ED shift that evening. This gave opportunity to a physician with a rotating “0” type internship credential to walk into an unknown ED with great confidence, however misplaced, to cover the shift. After a brief “Who are you?” from the charge nurse, patient care began in an environment that the media often referred to as the knife and gun club of San Diego.

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Two years later, the first contract to staff the hospital ED came along. An essential preparatory step was creation of a professional corporation, an essential tool for all emergency physicians. Quickly, the hospital started finding reasons to lower the payment terms. A brutal fact of EM practice was evident.

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An emergency physician can be out of a job in 90 days for a variety of reasons but primary among the reasons is administration laboring over the check they write to you each month. Future security will demand an increased element of financial independence was the message. A partial solution to this problem was creation of a billing and collecting company, an idea that could also solve other folks' problems, generate an alternative source of income, and be a viable business to sell.

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Keeping in mind how tenuous even the best hospital contract relationship can be, additional hospital contracts were added, always on the lookout for other innovative things to do. Some seized innovative alternatives were not as good as others. How can one better the divine likelihood of success? Some might conclude that getting an MBA will facilitate optimal business decision making. The basic message of that 2-year saga is that if one starts to drift from one's core competency, ...

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