Originally Published: Common Sense, March/April 2012
Original Author: Leana S. Wen, MD MSc
|Jesse Pines, 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 fourth installment is a conversation with another rising star in EM: Dr. Jesse Pines. Dr. Pines is the Director of the Center for Health Care Quality and Associate Professor in the Department of Emergency Medicine and Health Policy at George Washington University. He has authored more than 120 peer-reviewed articles, two books and numerous other articles in both medical and lay publications.
LW: Tell me about your current positions, specifically your leadership posts and what you do in them.
Dr. Pines: I'm the Director of the Center for Health Care Quality at George Washington University. I'm also a practicing, board certified emergency physician and associate professor in the department of emergency medicine as well as health policy. In addition to practicing clinical medicine, teaching and research, I am very involved in U.S. health policy and contribute to both the medical and lay literature including writing for Time.com, Slate.com and Emergency Physicians Monthly. I also work part time as a senior advisor in the Research and Evaluation Group at the Center for Medicare and Medicaid Innovation Center.
LW: Can you tell our readers a bit about where you are from and where you got your training? Why did you choose emergency medicine?
Dr. Pines: I'm from Washington, DC originally. I went to Georgetown for medical school and received my MBA there too. In medical school, I was drawn to both surgery and EM. I ended up choosing EM because I like medicine and also like to do other things. I didn't know surgeons who were able to really have multiple careers, but I did know EPs who able to balance clinical with other interests. Then I went to residency at the University of Virginia in Charlottesville. There, along with the faculty, I helped to develop a clinical research program where we had undergraduate students enrolling patients in ongoing studies. This experience was a lot of fun. And it really drew me to focusing on research early on in my career. After residency, I went to Penn and got further training in research with a Master's degree in Clinical Epidemiology.
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. Pines: One of the most important things I learned from my mentors was how to do research, specifically how to ask answerable and important questions, and to focus on a particular niche. Early in my career, I became very interested in the issue of ED crowding. It was a natural fit. I was interested in the administrative aspects of health care, and I saw crowding as one of our specialty's biggest issues. More recently, I've become more interested in research in issues in diagnostic testing and provider variation, but I still love thinking about and studying issues related to crowding and patient flow. It's still a problem that's far from being solved.
LW: You have 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. Pines: There are several big problems. One major issue is poor care coordination. We as EPs understand this better than most doctors. Care coordination problems invariably end up on our doorsteps. There also are big issues with how doctors and hospitals are paid, specifically the underlying incentives around what we are paid to do, and not do, and why we get penalized. The big elephant in the room is tort reform, which has unfortunately not been the focus of recent reforms. One specific issue I'm active in working on is how to promote the use of clinical decision rules. Decision rules can help to reduce variation in how we test and treat patients. On a larger scale, decision rules can help us cut down on testing, but only if we decide as a specialty that decision rules are the standard of care. If specialty societies and government agencies start promoting decision rules, this could be a small, but important, step in reducing defensive medicine and costs of care. Because there are so many decision rules in emergency medicine, this is where we can really be leaders and set examples for other doctors.
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. Pines: I am very excited about being an EP, especially now. The reason is that I think we already do a fantastic job managing patients, but one of our skills – fixing problems through coordinating care – is underused. It will become more significant in the future as controlling costs become a more important consideration in medical decisionmaking in the future. In the coming years, as systems are built to manage and coordinate care for patients across multiple settings, it will become clear how important EPs are in this equation.
LW: You are widely recognized as a leader in your field. Do you have tips for young EPs for getting involved in leadership and advancing in their careers?
Dr. Pines: Yes. First of all, find a niche. And find it as early as you can. Second, make sure you have the skills to do what you are asked to. The skills for being a leader – for being a policy person or for doing epidemiology or biostatics research – are not necessarily skills taught in residency. You may need additional training or experience. The earlier you get the right skills, the quicker you can advance. Extra skills also help to differentiate you. Third, I cannot emphasize how important mentorship is. Just look around at people who succeeded early on, and you will see that there is a mentor behind the scenes who was there to guide them and create opportunities.
Editor's note: We would love to have your feedback on this column. Please send comments and suggest other leaders you would like to see profiled to firstname.lastname@example.org.