Original Author: Leana S. Wen, MD MSc
|Larry Weiss, MD JD FAAEM|
Past President of AAEM and professor of emergency medicine at the University of Maryland
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 second installment is a conversation with Dr. Larry Weiss, immediate past president of AAEM and professor of emergency medicine at the University of Maryland.
LW: Tell me about yourself. Where are you from? Where did you get your training?
Dr. Weiss: I'm from the Pittsburgh area and attended Hahnemann Medical College. I went down south and did my EM residency at Charity Hospital. When I graduated, I went back to Pittsburgh for several years but returned to Charity in 1990. I stayed there as faculty and had no intention of moving, but then Hurricane Katrina happened. I worked in tents in New Orleans until eight months after Katrina, but Charity never reopened, so I came to the University of Maryland to serve on the academic clinical faculty.
LW: You have a somewhat unusual educational path in that you also received your JD. What prompted you to go to law school? How do you incorporate your law training into your daily work?
Dr. Weiss: I went to law school because of my interest in health policy and advocacy. For years, I taught at LSU School of Law in addition to teaching EM, and I also worked as in-house counsel for a group of 100 EPs and actively litigated malpractice cases in defense of the EP. My single greatest love professionally is advocacy. I love being able to advocate for my patients and fellow physicians. As I went through my training, I saw that there are very few people advocating for physicians. AAEM was the perfect avenue for my advocacy and legal training. In my opinion, nobody else is advocating for EM physician practice rights. Let me give you an example. Twothirds of the calls I investigated as AAEM president were because physicians lost their medical staff privileges and were not getting access to fair hearings. They need an advocate who has their best interests at heart. These are the people I fight for. That's why AAEM is so indispensable.
LW: Is law school something you would recommend to other physicians-in-training who are interested in policy or advocacy?
Dr. Weiss: Absolutely. I would definitely recommend law school to those who are going into academics. Some people choose to subspecialize in ultrasound or toxicology; health law is another option. For me, getting my law degree gave me an automatic niche. Because law permeates every aspect of the hospital and the medical school, having legal training allowed me to get involved in legal issues in the academic center. Along with my colleague Jorge Martinez, we were often the only doctors who also had a JD, so we were consulted on a lot of hospital-wide policies. Even if you're not interested in academics, you can apply it to almost any other setting. I would definitely encourage readers who are interested in health law or policy to think about going to law school. Feel free to contact me at firstname.lastname@example.org if you want to talk about law school. It's great value in academics or really wherever you work.
LW: Speaking of health policy, what do you think are the major problems facing health care today, and how would you go about addressing them?
Dr. Weiss: One major problem is cost. If we want to make health care available to all, we have to get rid of the extra cost. These include things like unnecessary imaging, unnecessary admissions, and all the complications that come from lack of primary and preventive care. We should spend more up front with preventive care. Primary care also - the Affordable Care Act did a good job of shifting the focus to primary care; however, it failed to recognize emergency medicine as a primary care specialty. Also, we have to make sure that there are enough medical students entering primary care. In addition, we have to take a good look at how we manage end-of-life care. We provide a lot of unnecessary care to older people who don't want it.
LW: I'm sure you have thought a lot about the future of EM. Are you optimistic about the direction the field is taking?
Dr. Weiss: Let me start by saying that if I were finishing residency right now, I would be very excited about starting a career in EM. It's a great field, and I don't regret my decision to enter EM for one minute. At the same time, there are some things that trouble me. I am concerned about the steady erosion of our practice rights. In community hospitals, it has become standard practice to have restrictive covenants and no due process. The lay corporate practice of medicine is increasing. EPs have to get much more involved to advocate for our rights. We have to demand, at minimum, that every hospital extend the same due process rights to EPs that they do for every other member of the medical staff.
LW: Why do you think it is that more EPs are not getting involved in AAEM and advocacy?
Dr. Weiss: The problem isn't just involvement in AAEM; fewer and fewer physicians are getting involved with organized medicine, period. Less than 20% of doctors belong to the AMA. Part of it is that today's doctors guard their personal time more carefully. Being part of organized medicine means volunteering one's own time, and maybe there's less of a spirit of volunteerism. But we need to remember that in EM, our rights are imperiled. We will continue to lose rights if we are not proactive. We have to really wake up and do something before it's too late, for our specialty and our patients.
LW: You have held a number of leadership roles over the years. What would you say to someone who isn't involved but may be looking to develop more leadership skills?
Dr. Weiss: You can't be a leader if you're not involved, so get involved!
Do it early, as a student or resident if you can. You can make up your own minds about what organization you want to be involved in. Just think about which one cares about specialty rights, about you and your patients. If you disagree with the AMA, fine, you can still get active in your state medical society or EM organizations. Obviously, I'm biased towards AAEM, and here's another reason why: it's relatively easy to get involved with us. There are a lot of opportunities to get involved with task forces and committees. Just email email@example.com or look on our website. Part of leadership also involves liaising with other specialties. If we help other specialties, they will help us. Remember that EM does not exist in isolation; it's all part of a bigger system.
Editor's note: We would love to have your feedback on this new column. Please send comments and suggest other leaders you would like to see profiled to firstname.lastname@example.org.