Outside of academia: The view from community-based PEM

Dr. Kay Hesse spends part of her time working as a PEM provider at a community hospital. In this guest article, she shares her perspectives on working outside of the world of academics.

by Kay Hesse MD MPH

Through most of my pediatric emergency medicine training and experience, I never acknowledged that a world outside of the silo of academia was possible for me. I have been the receiving doc at a children’s hospital for many patients transferred in from community hospitals, often on hour-long middle-of-the-night journeys, only to frequently discharge them straight back home again from the emergency department. So when Emergency Medicine Physicians—a privately managed EM physician group—contacted me about taking a community-based PEM position, I had never even heard of them before. My ignorance on community-based PEM was not due to any shortcomings of EMP, but rather was a reflection of my limited view of the world of emergency medicine from within the academic silo.

This new venture appealed on many levels. The position included working part of my clinical duties at the children’s hospital so I would be able to enjoy the best of both worlds:  provide PEM care in the community setting yet still participate in teaching and working in a tertiary care setting. Taking this community-based pediatric emergency medicine position seemed like a chance to help prevent unnecessary late night transfers. Additionally, with the community hospital starting a pediatric hospitalist program, we hoped to help our patients by admitting them locally for many straightforward pediatric ailments.

As PEM docs not only do we have an increased comfort level managing a wide range pediatric pathology, but our training also affords us the ability to offer PEM education to our general ED colleagues. For example, we now hold regular Pedi ED SIM sessions in the main ED. Being in this community setting has inspired us to explore PEM telemedicine initiatives to further enhance the quality of PEM care to other non-PEM EDs.

Although we have found many expertise and equipment areas in need of improvement in the community setting, our work has also been met with enthusiasm by the community hospital. The radiologists are working to improve their comfort with appendicitis and intussusception ultrasounds, orthopedists are more willing to come in for sedated fracture reductions with the mini C-arm, we are stocking fast-absorbing sutures, nasal atomizers, increasing med formulary offerings, and overhauling the code carts.

The learning has been a two way street. For example, coming from a well-staffed academic center, it was initially unnerving to perform both procedural sedation as well as the procedure as a solo doc on duty.  However, with an astute nursing and tech staff with me, this process sits with me more comfortably now. And getting to actually do all of the procedures personally has been a great skill set refresher for me.

I suspect most of us in PEM are a bit fickle and thrive on variety in our worlds. This combination of independently caring for patients at the community hospital and functioning in a teaching and supervisory role in academia really makes me feel like I am getting to have my cake and eat it, too. As the climate of healthcare is changing, I suspect such opportunities as this will increase across the country. I would totally endorse exploring such ‘hybrid’ positions. I am honored to be serving such an important role for our community and families.

KHesseKay Hesse, MD MPH, is the Medical Director of the Pediatric Emergency Medicine program at Lawrence and Memorial Hospital in New London, Connecticut