Unfunded Mandates: How ER Docs Bear the Cost of America's Healthcare Crisis
Send us a textDr Gillian Schmitz former ACEP president and current vice chair of education at Naval Medical Center San Diego, examines emergency medicine's financial crisis and its consequences. She identifies the fundamental contradiction in how America treats emergency care as a universal right while funding it as a privilege, creating an unsustainable system where nearly 70% of ED patients don't cover their care costs.• Former ACEP president with extensive experience in civilian and military emergency medicine• Healthcare in America faces a fundamental conflict between right vs privilege approaches• Nearly 70% of emergency department patients don't pay the full cost of care• Insurance companies making billions while avoiding fair payment for emergency services• Boarding and overcrowding have reached dangerous levels affecting patient safety• Physician groups facing consolidation as independent practice becomes financially nonviable• Potential solutions include better insurance accountability and reconsidering funding models• Some physicians consider unionization and collective action as necessary steps• Media portrayal through shows like "The Pit" helps public understand emergency medicine challengesWe need the public to understand how emergency care is funded – or not funded – and the impact of this unfunded mandate on the entire healthcare system. Without addressing the root cause, boarding, violence, and consolidation will continue to worsen.Support the show
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19:11
The Real Crisis in the ER: Systemic Dysfunction vs Financial Concerns
Send us a textThe ACEP and RAND StudyInterview with David Schriger, Peter Viccellio, and Al Sacchetti, MD'sFour 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 improvementsListen to our next episode where we'll explore how new emergency physicians can advocate for better workplace conditions despite institutional resistance.Support the show
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38:46
Physician, Heal Thyself (Without Losing Your License)
Send us a textThe 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 SimmonsLinks: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/wellnessDr. 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 changesVisit 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.Support the show
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22:56
The Nocturnists Present: Inside 'The Pit': Medicine's Most Authentic TV Drama
Send us a textThe Nocturnists Podcast with Emily Silverman, MDThe 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.Support the show
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Burnout and Coaching with Scott Weingart
Send us a textLink 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 careerCall us or visit our website to learn more about physician executive coaching and register for upcoming sessions.Support the show
Mel Herbert, MD, and the creators of EM:RAP, UCMAX, CorePendium, and the collaborators on "The Pitt" and many of the most influential medical education series present a new free podcast: “Dirty White Coat.” Join us twice a month as we dive into all things medicine—from AI to venture capital, long COVID to ketamine, RFK Jr. to Ozempic, and so much more. Created by doctors for clinicians of all levels and anyone interested in medicine, this show delivers expert insights, engaging discussions, and the humor we all desperately need more of!
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