As a "senior" physician who still enjoys working full time I find the
discussion interesting. 

We are a very young subspecialty. There are only a few of us who go back
to the original retreat that established PEM as a subspecialty in 1987
or 1988. At some point we will all have to face the issues of longevity
in a complex specialty. The experience and skills of senior physicians
is valuable to the department. That experience and the opportunity to
pass it on keeps me going. We need to find a way to keep those
experienced physician practicing as long as they are able, recognizing
that there are will be some limitations. Better to plan for it than face
the loss of so much talent


This on-line discussion mimics the ones adult side faced a few years
ago.  Now they recognize it as an issue.  ACEP have a number of
excellent resources and I have enclosed their policy.



Or department exempts physicians from nights at around 55.  New hires
understand that they will need to work more nights but that they will
with time work less. Our second evening shift is a bear (5PM to 2AM). It
is not just the issue of being sharp at 0300 it is the issue of recovery
that changes with age no mater what we think or hope. 




Mary Bridge Children's Hospital 





Considerations for Emergency Physicians in Pre-retirement Years  


Originally approved by the ACEP Board of Directors June 2009 


The American College of Emergency Physicians recognizes that an
increasing percentage of its members are entering retirement or
pre-retirement years. In an effort to enhance and prolong the careers of
emergency physicians in the latter stages of their professional lives,
to ensure patient safety, to promote continued membership and
participation in the College, and to facilitate the transition of
emergency physicians from active practice to semi- or full retirement,
the following guidelines are offered:


*         Physicians and physician groups are encouraged to be mindful
of the limitations that may accompany the aging process. In compliance
with age discrimination laws, appropriate policies to evaluate and, to
the extent possible, accommodate specific limitations can provide the
senior physician with a supportive environment in which to deliver
quality care. 

*         As may be feasible or appropriate, a variety of work load
modifications can be implemented: 

*         Consider minimizing or eliminating assignments to rotating,
late evening or night shifts as a means of minimizing circadian stress. 

*         Encourage older providers to work more day shifts on weekends
in exchange for night shift assignments. 

*         Follow scientifically-based scheduling recommendations when
possible. This may include consistently scheduling senior physicians to
a single shift segment of the day/night cycle to preserve a period of
core sleep, or scheduling clockwise rotations (morning, afternoon and
night) to minimize circadian disruption. 

*         Consider scheduling additional time off for recovery after
night shifts. 

*         When possible, shorten shifts to periods of eight to ten hours
or less, and schedule fewer consecutive clinical shifts. 

*         When possible, adopt scheduling strategies that best match
patient volume and acuity to the work pace of the senior physician. 

*         When possible, allow those senior physicians who are willing
to exchange clinical responsibilities for administrative or teaching
duties to obtain the requisite training to do so.  


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Chamberlain, Jim
Sent: Saturday, April 10, 2010 1:05 PM
To: [log in to unmask]
Subject: Re: Survey - Workload Modifications for Older Physicians


I agree with you about clinical skills but I just can't do night shifts

like I used to. I fade after 3 AM and it's not safe for patients.


James Chamberlain, MD

Division Chief, Emergency Medicine

Children's National Medical Center

111 Michigan Avenue, NW

Washington, DC 20010


202.476.3253 (O)

202.476.3573 (F)

202.476.5433 (Emergency Access)


-----Original Message-----

From: Pediatric Emergency Medicine Discussion List

[mailto:[log in to unmask]] On Behalf Of Pamela Beach-reber

Sent: Saturday, April 10, 2010 9:22 AM

To: [log in to unmask]

Subject: Re: Survey - Workload Modifications for Older Physicians


As a PEM physician of 61 yrs young, I am insulted that many of you

believe that we need to cut down on our workload. I have been practicing

for 36+ yrs and have no intention of slowing down anytime soon. I don't

practice for the money but because I feel with all the experience and

knowledge I have attained, I have way more to offer the patient than the

"youngsters" practicing out there. I feel that we need to teach them

that medicine is an art, not just a cookbook of practice parameters. We

have seen it all and do what we do well. So why quit?

Personally, I like working with "older" established physicians (and

nurses too for that matter). We don't have to make sudden changes in the

schedule for soccer games, our own sick children, or babysitters that

don't show up. Only problem is, we may have a stroke or angina during

our shift!

We older docs need to hang in there and be a model to the rest of you

guys. When we finally can do our jobs so well, why quit?


----- Original Message -----

From: "Doc Holiday" <[log in to unmask]>

To: [log in to unmask]

Sent: Friday, April 9, 2010 7:34:36 PM GMT -05:00 US/Canada Eastern

Subject: Re: Survey - Workload Modifications for Older Physicians


From: [log in to unmask]

> our older doc (60+!!) has no accomodations made for him despite a full

time position. As we are a private practice any accomodations would cost

him $




--> This topic of the life of an EP is of great interest to me. I spend

much of my time trying to understand the system in the USA and to make

comparisons with EM in the UK (I also give lectures on the topic in the

UK and in the USA). I try to use these comparisons to help either side

learn from the good ideas from across the Atlantic.




On the issue of modifying the career of EPs to suit them as they gain

years in the profession, I believe the system in the UK is significantly

kinder than the one in the USA. Most of this is NOT by intention, but

through the design of career pathways here, with this being a positive





Money and how it drives healthcare differently in the UK & the USA is,

as you demonstrate here, a MAJOR factor!




> I have been in centers where folks over 50 no longer work overnights




--> We have one like that here - it's called the UK (as far as EM

consultants are concerned)... Our career "pyramid" sees to it, but it's

NOT an age-related principle. It is related to the fact that EM

consultants don't do nights. But they also have their career path

annually appraised and the system allows them and promotes the shift to

a less clinically-intensive and more teaching or management or other

aspects as one progresses WITH HIGHER PAY despite this!




(Please note - ALL EM consultants in the UK are what you'd call





BTW, you put two exclamation marks after "60+", why did you do that? Is

it because you are suprised that someone is still working at that age?

I'd be curious to know. Thanks.



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