Original Author: Leana Wen, MD MSc
|Mark Reiter, MD MBA FAAEM|
This is a new column in Common Sense where Dr. Leana S. Wen, AAEM/RSA secretary/treasurer, interviews leaders in emergency medicine about their experiences, perspectives and insights. The third installment is a conversation with a rising star in EM: Dr. Mark Reiter. Dr. Reiter is an attending emergency physician at St. Luke's Hospital in Bethlehem. He has held a number of leadership roles, including past AAEM/RSA president and current AAEM secretary/treasurer. He has been on the AAEM Board since 2005.
LW: Tell me about your current position and what you do.
Dr. Reiter: I'm a practicing emergency physician at St. Luke's Hospital in Bethlehem, Pennsylvania, where I am a member of the core faculty for our emergency medicine residency program. I'm also the CEO of Emergency Excellence, a company whose aim is to improve emergency department processes and performance.
LW: Where are you from and where you did you get your training?
Dr. Reiter: I grew up in New Jersey and graduated from Rutgers College. Then, I enrolled in an accelerated BA /MD program with the UMDNJ-Robert Wood Johnson Medical School. During this time, I also earned an MBA from Rutgers Business School. I then moved south for emergency medicine residency at the University of North Carolina-Chapel Hill.
LW: Why did you choose emergency medicine?
Dr. Reiter: I chose EM because I wanted to be a real doctor – someone who has a significant impact on people's lives.
LW: You've held a number of leadership positions. When did you start becoming involved?
Dr. Reiter: I starting getting involved in organized medicine in medical school, where I became very active within the American Medical Association (AMA). Later, as a student, I served as president of the New Jersey Medical Student Association and served on the Board of Trustees of the Medical Society of New Jersey. As a resident, I was appointed to the AMA Council on Legislation and served as vice chair of the North Carolina Medical Society Resident Section. In residency, I became very involved in AAEM. I was elected president of AAEM/RSA, which has a dual role as a member of the AAEM board of directors, and was a great opportunity to work with many of emergency medicine's finest leaders. Since then, I have continued to serve on the AAEM board of directors and am now the AAEM secretary/treasurer.
LW: How did you get interested in your particular areas of expertise? Any lessons from your training that you'd like to share with us.
Dr. Reiter: For me, being involved in organized medicine has been incredibly useful. I'd encourage all physicians, no matter what field or what stage of training, to get involved with professional organizations. You have to be involved to see the big picture, which allows you to advocate more effectively for your patients, your colleagues and your profession. Additional training, such as my MBA , has also helped prepare me to become a more effective leader within professional organizations and within the emergency department.
LW: You have had significant involvement in shaping health policy. What do you think are the major problems facing health care today, and how would you go about addressing them?
Dr. Reiter: Overall, the U.S. is delivering quality care – but we are not doing so in a sustainable way. Medical expenses are out of control, and there is far too much waste and overutilization. We have not implemented cost sharing in an effective way. Eventually, we need to realize we can't provide all possible care for all situations and move to some type of intelligent rationing like what was proposed in Washington a few years ago.
LW: You've talked before about physician payment reform. Can you elaborate on this?
Dr. Reiter: The current incentives for doctors don't make sense: actually, doctors are incentivized to prescribe maximal health services. The more you do, the more you get paid. You see this especially with doctors who own MRIs and echo machines and utilize these tests at rates far exceeding those who don't own the same equipment. All of this increases the utilization of medical services without added benefit. Defensive medicine is a huge problem, especially in emergency medicine, and will remain a huge problem until real tort reform is instituted. Then there are other problems, like poor coordination of medical services, subpar IT infrastructure, and interoperability and the problems with intermediaries like insurance companies and practice management groups. I can go on, but you get the point – there is a lot for us to do!
LW: I'm sure you have thought a lot about the future of EM. Are you excited about being an EP in this era?
Dr. Reiter: I am excited about being an EP, but the future of EM to me is deeply concerning. We blew an enormous opportunity in 2009 and 2010. This was America's best opportunity since Medicare was implemented to make significant, positive changes in our health care system. Instead of real reform, all we did was greatly expand the least effective insurance program (Medicaid), pay for more prescription drug coverage for Medicare, and add a ton of additional health care bureaucracy. We had a great opportunity to pass real tort reform, but we didn't. We had a great opportunity to create an effective, coordinated health care SYS TEM, but instead, we once again added a bunch of spare parts that don't make sense. That just means it's even more important now than ever to get involved and make a difference.
LW: Do you have tips for young EPs who want to make a difference?
Dr. Reiter: If your goal is to make an impact, the only way to do is to become involved. First, be informed about the issues. Find out what ssues move you. Educate yourself. Then, get involved in professional societies and advocacy organizations. Organizations both inside and outside of EM are invaluable. Then, when you're ready, get involved with politics. EPs need to start talking with legislators. They are ready and willing to listen to us, and only by talking to people who make the laws are we going to make the national change on a systems level that's really going to make an impact.
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