Spotlight On Leaders in Emergency Medicine: Michael Epter, DO FAAEM

Originally Published: Common Sense , May/June 2012
Original Author: Leana S. Wen, MD MSc

AAEM/RSA President

Michael Epter, DO FAAEM

This is a new column in Common Sense where Dr. Leana S. Wen, AAEM/RSA president, interviews leaders in emergency medicine about their experiences, perspectives, and insights. The fifth installment is a conversation with a leader in EM and AAEM: Dr. Michael Epter. Dr. Epter is the Program Director and Vice-Chair of Education at the University of Nevada. He has held a number of leadership roles, including President of the Young Physicians Section, member of the AAEM board of directors, and Chair of the Education Committee. Dr. Epter is a recipient of AAEM/RSA’s Program Director of the Year award.

LW: Tell me about your current position and what you do.
Dr. Epter: I currently serve as the Program Director and
Vice-Chair of Education at the University of Nevada. Our program is located in the heart of Las Vegas at University Medical Center, which is the only Level 1 Trauma Center and Burn Center in the state of Nevada. As expected in my current position, the majority of my efforts are devoted to being a clinician-educator, with a smaller portion directed toward research. Teaching is my passion and finds itself at the heart of everything I do. It makes working not a job, but a profession that I am privileged to be part of.


LW: Where are you from and where you did you get your training?
Dr. Epter: I am originally from New York. I attended New York College of Osteopathic Medicine and completed my residency at Albert Einstein College of Medicine at Beth Israel Medical Center in New York City. My initial practice environment was not as an academician, but rather in a community ED within Brooklyn. In 2005, I relocated to Las Vegas, NV, to initiate the process of starting an EM program that began in 2006.

LW: Why did you choose emergency medicine?
Dr. Epter: Like many of us, my decision to enter EM was multifactorial. I did have some initial exposure to EM through EMS, but while progressing through medical school and starting clinical rotations, I could not find my passion within the “core” rotations. It was during my EM rotation that I developed a strong affinity for what I feel we do better than any other specialty: treating/managing patients with undifferentiated medical problems. What I didn’t know then but have realized over time is the breadth of EM and how many primary, “front line” opportunities there are for us to have an impact and feel rewarded professionally as well as personally.

LW: You’ve been a leader within AAEM in a variety of capacities. How did you first get involved?
Dr. Epter: As for many of us, my initial exposure to AAEM came during my residency training, when Dr. Robert McNamara visited our program. I appreciated and admired the advocacy that the organization was providing for emergency physicians’ practice rights, as well as ensuring academic standards and professional integrity.

I joined with the sense of confidence and support from the knowledge that AAEM “has my back.” What got me more involved beyond that was an email about the website 911emergency.org. This is a database of hospitals that have EDs staffed by at least one board certified emergency physician 24 hours a day, seven days a week. At the time, the hospital I was working in qualified for this website, and I was proud of this and of informing the global community of EPs. All I did was complete a one-page verification, but I felt a tremendous sense of duty: I was being an advocate for our profession and letting our patients — the ones we serve — know that there is a difference in whom is providing their care. This just illustrates how one simple action can be life-changing and how little it can take to begin to make a difference.

LW: What would you say to trainees and young EPs about why to get involved in AAEM?
Dr. Epter: This is simple: You are the organization’s future! I truly believe that all individuals have the ability to do great things. This is a conscious choice — embrace it! You too can play an integral role in advancing our field amidst the evolving challenges of our specialty: workload, patient satisfaction, overcrowding, board certification, wellness, and corporate practice without democratic principles/management. Even though we continue to increase our membership, I relish the fact that we are still a smaller organization; this affords opportunities for young EPs to routinely meet people and develop lifelong mentoring relationships. As previously mentioned, the concept of “having your back” is easily felt, due to our close-knit nature within AAEM. It is this mutual support that defines the practice of EM and gives us the ability to care for our patients.

LW: What do you see as the future of EM?
Dr. Epter: While I continue to be passionate about EM and privileged to count myself amongst the many EPs within the field, I believe it is wise for all of us to approach the future of EM with cautious optimism and not have unbridled enthusiasm. The future holds many unknowns and potential concerns. This summer, we await the decision of the Supreme Court on the health care bill which could certainly impact our daily practice. Already, we face increasing demands on our practice that I mentioned previously. In addition, there is the potential that we will be asked by hospitals to provide services beyond our scope of practice in an effort to reduce costs. Tort reform is still an issue to tackle at the legislative level. My ultimate concern beyond the aforementioned is the transition and rebranding of EM into a business, whereby the primary focus becomes metrics (e.g., door-to-doctor times, productivity, RVU/pt, etc.), rather than the critical physician-patient therapeutic relationship. There needs to be a balance between the business aspect and bedside care, otherwise there could be worse and higher burnout among EPs. These are some of the issues that AAEM leaders are addressing today and that leaders like you can have an impact on tomorrow by becoming an advocate for your profession, your colleagues, and your patients.

LW: What advice on leadership do you have for young EPs?
Dr. Epter: The word “leadership” conjures up a vast range of emotions for me, ranging from fear and apprehension (think of your first ever intubation) to excitement and inspiration (think of your first successful resuscitation or cricothyrotomy on a patient with angioedema, or graduating and landing the “perfect job”). My bottom line on leadership is the following: Be ferociously persistent in the pursuit of perfection of what you are trying to obtain. Maintain your vision. Perfection may outdistance you, but you will end up achieving excellence. Though “ferocious” in your persistence, be humble at the same time.

One of our great presidents, President Truman, noted that as long as you don’t mind who gets the credit, you can accomplish great things in life. Take your ego out of it. So, under-promise and over-deliver, “walk the talk,” and finally, nothing is ever achieved without passion and giving thanks to people who supported you in the process.

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 wen.leana@gmail.com.