|Tom Scaletta, MD FAAEM|
Original Author: Mary Calderone, MS3
AAEM/RSA Medical Student Council President
MC: What is your current position, and how did you get to it?
Dr. Scaletta: My first job was at San Francisco General (a county hospital/trauma center). We were a division of surgery and without our own EM residency program. I did work with many brilliant UCSF
residents, watching their temporal arteries pulsate as they constructed elaborate differentials to explain a presentation of dyspnea. My job was to point out when it was time to stop talking and start intubating. SF General eventually approved an independent department of EM and started a highly regarded EM residency program. Prior, I had moved back to Chicago to be closer to my family and became associate director of the ED at Cook County. Later, I became medical director at two high-volume community hospitals — initially West Suburban (Oak Park, IL), where we started the first EM group in the country to meet the AAEM fairness criteria — and now at Edward (Naperville, IL).
MC: What challenges are unique to your position? What do you enjoy most about it?
Dr. Scaletta: Edward is a top performing ED, especially with regard to patient satisfaction. Leading is about forward thinking, problem solving, and project management. In the next five years we will be forced to greatly curtail the cost of health care through very judicious admission rates, a statistic where EPs vary widely. With this prediction in mind, I am identifying our outliers and helping them change. Consequently, I am caught between being respectful of practice autonomy and protecting job security in a future totally unforgiving of wastefulness. As an AAEM leader, I advocate for practice rights, but as a medical director, I encourage necessary change.
MC: Tell us about your involvement in AAEM.
Dr. Scaletta: Getting involved in AAEM was a pivotal moment in my life. In 1996, when attending the Cook County trauma unit, a resident from the local osteopathic program explained that his program director held contracts at several inner-city, ambulance-receiving EDs where his residents moonlit alone overnight. Imagine being a junior resident tossed into a high acuity ED for $50 a night shift in order to stay in the good graces of your program director. This was wrong on many levels — abuse of power, inappropriate profiteering, and unqualified coverage.
I informed the president of Illinois ACEP that I wanted to do something, and he suggested writing a discussion paper. My first version included all the specifics, and a redacted version was to be sent out to board members. Inadvertently, Illinois ACEP mailed both versions. Two months later, I received a letter from a prestigious Chicago law firm representing the contract holder and threatening me with a defamation lawsuit, something not covered by malpractice or homeowners insurance. Let’s just say there was a lot of explaining to do with my wife, as we had recently moved into the first house we ever bought, and she had just delivered our first baby. Incredibly, ACEP said I was on my own in sorting the issue out.
I contacted AAEM, and within 15 minutes was speaking with then President Bob McNamara. I’ll never forget what he said. “Tom, this is great news! This is exactly what we’re about. We can definitely help you.” I was then put in contact with Joe Wood, the AAEM VP who was an MD/JD. Joe made it clear I would be OK. He emphasized that “the truth is a great defense,” and that AAEM had a legal fund. I immediately joined and became progressively more involved. I went from chairing the Academic Affairs Committee to being elected to the board, and then moved all the way up to president from 2006-2008. AAEM was all about advocating for others. As president, I received a call every other week from someone unfairly treated by a contract holder and routinely engaged AAEM’s resources to help.
MC: What would you say to trainees and young EPs about why to get involved in AAEM?
Dr. Scaletta: AAEM is a totally authentic organization. The board facilitates EPs’ ability to take great care of patients. AAEM is also agile. If you want to accomplish something within the organization, the organization will move as fast as you do. By putting in time and energy, you are rewarded by seeing the tangible benefits of your efforts. While a lot of other organizations try to shape their members and dictate what they do, AAEM is more like a piece of clay that its members can mold.
MC: What has changed the most about emergency medicine since you entered the field?
Dr. Scaletta: When I started, the ED was the back door of the hospital. It served necessary function but was not a place where growth was fostered. Later in my career, the ED became the front door for marketing since a great ED experience encourages use of other hospital services. Nationally, there are nearly two ED cases a year per five members of society. As a patient or visitor, more people are exposed to the ED than any other single hospital service. Right now, the ED is becoming the hub of the enterprise — the most important area influencing whether a hospital fails or succeeds financially. This is why EPs must be adept at minimizing admissions and avoiding expensive tests without compromising patient safety.
MC: What are your specific areas of interest and why?
Dr. Scaletta: Patient satisfaction is my main area of interest. We are working on innovative ways to achieve high satisfaction, and I always enjoy speaking with other ED directors to share ideas. The skills necessary for an optimal patient experience are not adequately taught in residency (like empathy). In fact, some doctors are offended when their bedside manner is scrutinized. They feel satisfaction is mostly superfluous. To me, the best EPs have three primary attributes — they are fast, nice, and smart. By this, I mean they can move patients, satisfy patients, and provide high quality care. Being a great EP means connecting with the patient within two minutes, so that their trust in you persists for the next two hours. ■