Dr. Scott Hickey: Advocating for ourselves equates to better clinical care
Dr. Scott Hickey — president of the Virginia College of Emergency Physicians — often thought about how the doctor who cared for him in his youth had a positive impact on him.
His physician was the type who made follow-up calls for routine office sick visits, for example. He was dedicated to his patients.
Now with a decorated medical career himself, Hickey has also made a name for himself for his tireless care as physician. A few years ago, for example, he won a first-place award for Best Bedside Manner.
What do you love most about emergency medicine and why did you choose it?
I chose EM because I loathed being attached to a pager. It didn’t make sense to me that a physician would work all day, take a call, be up all night admitting patients or operating, and then work the next day. A 36- to 48-hour workday was not in the cards for me. I liked the idea of going to work and ending a shift. Fast forward, and I ended up being a department director for over 10 years and essentially being on-call 24/7, 365 days a year; I had a never-ending shift.
Who was your biggest influence growing up?
My father. Dad was our (I have a sister and brother) biggest fan and cheerleader. He rarely, if ever, missed an event or important occasion. He worked with his hands his entire life and preached education as a way to advance in life. We knew that school was our job and that anything less than excellent performance was unacceptable.
How has your past influenced where you are now?
Unfortunately, I had a lot of interaction with doctors and hospitals when I was a kid. We had an exceptional pediatrician in the rural area of New York where I grew up. In retrospect, I appreciate just how exceptional he was. He knew what was important and what wasn’t as important for his patients’ and their parents’ health. He would make follow-up calls for routine office sick visits. He was the doctor who did show up in the ER to evaluate his patients. He was the doctor whose office my parents brought me to when I needed stitches after being hit by a car riding my bike. He was profoundly dedicated to his patients, and I think of him often.
What do you hope for the future of emergency medicine?
My hope is that EM will remain a viable profession and career for physicians. My hope is that EM physicians will continue to be valued members of a hospital medical staff. My hope is that hospital systems and hospital administrators will invest the resources needed to effectively and efficiently operate the proverbial ER “front door” of the hospital.
Where do you see the profession of emergency medicine going in the next 10 years?
The positive and revolutionary medicine that we will practice going forward will be awesome, potentially including therapy tailored to a patient’s genetics; targeted therapies for specific disease; and continued use of less invasive strategies to manage complex problems. As EM physicians, we will continue to provide more and more definitive care. We will be able to admit fewer patients, but those that we do admit will likely be exceptionally sick. We will continue to ascend the clinical expertise ladder and be sought after by many specialties, to help manage their acutely ill patients.
Unfortunately, we will continue to experience receding respect for our expertise from health systems, administrators, and insurance companies. These entities will continue to look toward lower cost labor, including NPs/PAs. Large health systems are establishing footholds in online and in-person schools to generate a workforce of RNs and NPs. EM doctors will be expected to supervise an increasing number of APPs as they replace physicians on duty. The healthcare industry is focused on margin and achieving that margin by managing its most expensive line item: staffing.
We will likely be facing longer times to achieve ED care as staffing in EDs is bare bones. Hospital systems will continue to pressure the ED staff to achieve time and patient satisfaction metrics while reducing resources to provide the services expected of our patients. The proliferation of healthcare industry non-clinician executives and managers focused on metrics/margin, without the experience of bedside care, will continue to erode the quality and desirability of our hospital-based practices.
How will emergency medicine change in a post-COVID-19 world?
Using personal protective equipment will become more routine than before the COVID-19 outbreak. Once a COVID-19 vaccine becomes commonplace, there will likely be a system in place to routinely determine whether patients have received the vaccine. I believe we’ll also see advancements, or even major overhauls, in things like intubation boxes and ventilators, and we’ll likely see progress in disease detection in relation to acute inflammation. While the coronavirus forced a major shift toward online learning, we’ll continue to see more online college classes than prior to the pandemic. It’s a shift that will forever change the business of education. We need to remember the early days of COVID and continue to advocate for due process, while promoting our emergency physicians’ expertise in managing crises. We can’t allow corporations to dismiss our professional expertise, or else we risk business interests dictating medical care. We cannot place financial interests ahead of the safety and health of medical staff.
What are you most proud of accomplishing?
Professionally, I’m most proud of having the opportunity to build a large and thriving EM group. While we have always been part of a CMG, we have been able to operate on the local level with autonomy. We have built a great group of residency-trained and board-certified EM doctors. We have hired APPs that, in most cases, we have trained since they finished school. We’ve developed good relationships with in-state EM programs and have recruited really skilled and personable physicians. We have most certainly elevated the care in our EDs compared to 10 years ago.
How has emergency medicine changed since you started your career?
We’re much more aggressive in our clinical management. Our specialist colleagues know and expect us to practice to our highest abilities. We are respected members of the hospital staff and are being sought to lead initiatives throughout the healthcare system. We have a wide breadth of perspective because we interface with almost every service line and clinical specialty in our hospitals.
How have you changed since you started your career?
I was always impressed by senior clinicians in the ER who appeared relaxed and un-phased by what appeared to me to be the sky falling with a rack full of patients to be seen. I feel so much better after 15 years of practice knowing that we’ll get to the patients and we’ll attend to those most sick quickly. There will always be patients to be seen; the rack will be full; and we'll work hard to ensure staff and our patients are safe.
This is a broad generalization, but I’m concerned about the current generation of EM physicians completing residency. My experience has been that they’re not as committed to being good citizens within the hospital. We’ve had to cajole and strong-arm them into participating in hospital affairs outside of clinical shifts. There has definitely been a decline in the number of shifts EM physicians are working. In past years, 140-180 hours/month was the norm. Now, we have folks working 80-100 hours/month as full-time. I worry that without intensive practice in the initial years after residency, new graduates will stall in their maturation as expert clinicians. Further, it takes thousands of hours of practice to learn how to effectively manage the ER during a clinical shift.
What do you do in your free time outside of the ED?
We have four middle and high school children. Enough said.
What was your first impression of ACEP/VACEP?
My great personal and professional friend, Shawn Borich, encouraged me to become involved. I really didn’t know what VACEP did, but I knew it was EM focused. At first, I didn’t understand why we weren’t talking about clinical care, treatment guidelines, and ED operations. It took me awhile to appreciate our mission, to support our physician members and serve as their advocates. My dad was involved with his labor union’s leadership, and I started to look at VACEP as our professional union. We have to advocate for ourselves. We have labored long and hard through college, medical school, residency, and into our clinical practices. Our fund of knowledge and bedside experience are our work product, and we must promote ourselves within the healthcare industry. By supporting and advocating for my peers, we ultimately do elevate the clinical care provided in our institutions.
