Why I’m leaving the ER | Expert Opinion

I have a new job in a new world.

For more than 20 years, I had one primary goal: being a doctor in Philadelphia. I’ve been near-singularly focused on attaining the knowledge and skills of medicine, honing and pushing my role as an emergency physician, and holding the responsibilities of being on the front line close to and constantly on my mind.

But now, I’ve chosen to bring these skills and perspectives to a new job in my career. I’m still trying to figure out if that makes me a new person.

I remain committed to the same goals that brought me to emergency medicine. But I am tired of only being downstream, of being on the receiving end of failed systems and policies as they present in my patients, and feeling near helpless to prevent any of it. I’m ready to step outside of the emergency department to try to make a difference well before my patients would have needed me.

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As an emergency physician and public health specialist, I have fought to elevate the voices of my patients and the experiences of my clinical team. I have amplified calls for systemic changes to help the people who need it most — whether it be those with substance use disorder, mental illness, limited access to care, or vulnerable populations who may be overlooked. But throughout it all, I am, at my core, a clinician – someone who evaluates, diagnoses, and manages. The emergency department — with its unique sounds, sights, smells, and sensations — is the space in which I can stretch and fill into the skills, knowledge, instinct, and ethics I have worked to cultivate over decades.

The doors into and out of the emergency department have been another story. My colleagues and I are at the constant mercy of the systems around us — how and why patients come to us and how they leave us, what they face far from our doors. Any variation on the outside has a dramatic impact on the inside of the ED.

The backdoor of the emergency department opens to the hospital. When the hospital is full, we hold the sickest patients in the ED until a bed is available, resulting in fewer spots for those still in the waiting room. A full hospital only means that the hospital has reached its capacity based on available nurses. Entire sections of open beds remained unfilled, even while the waiting rooms remained packed. Patients could wait days for a bed to open up or ambulance transportation to transfer them to another facility. As hospitals close around us due to financial constraints and mismanagement, the problem has only gotten worse.

From outside my ED, I am haunted by the numbers. More than 1 million are dead from COVID-19. There have been more than 100,000 overdose deaths in 12 months, and more than 18,000 gun-related deaths (more than half of which were suicides) in the first six months of 2022. This includes 19 graduating fourth graders and 10 Black grocery shoppers in May alone. Every single one of these likely went through or touched an emergency department. Another ED team did everything it could to prevent these deaths in some way.

After hearing the horrific news from Uvalde, Texas, I felt deep despair — not only for the parents and families of the children shot and killed, but for the hospital teams that received one after another little body needing so much more than they could offer. It can be an unbearable weight to carry — to want to do everything possible to prevent a death, when the systems and world around you make it impossible.

Last week, I realized that despair has no bottom. Another shooter murdered four people — two physicians, a medical staff member and a visitor, in Tulsa, Okla. Being unable to keep our colleagues and patients safe and wondering if we too are at daily risk within the hospital realm is not a weight any of us should have to carry.

It could seem that the COVID-19 pandemic brought me to this point. It didn’t. Years before, I had started to see chinks in the armor of the health-care systems in our region, most especially for the patients, populations, and communities around which my career developed. We were not meeting the needs of those who needed us most.

“We were not meeting the needs of those who needed us most.”

My personal goals, missions, and guiding principles have remained largely unchanged throughout my career. Even when I didn’t always know how to articulate them, I knew what they felt like. I have trusted and relied on that feeling to seek out new ways to address health disparities, health-care inequities, and pleas for help from the communities I’ve served.

But it no longer feels right to work within the realm of hospitals and health systems. It seems the scarcity mind-set has taken over health care in our region. Being hyper focused on financial survival and thinking only to protect what you have do not make for safety in the workplace or for high-quality care for patients. And so, I am leaving.

Yet, I am far from resigned in pushing forward for what matters to me and where my skills and knowledge can have an impact. My career to date has been in the health systems, academic, and public sectors where sustainable change can be arduous and slow. These last few years have shown that the private sector can be nimble to population needs, has the infrastructure and resources to drive change, and is understanding that the return on investment in decreasing inequity may be as important as profit alone.

I bring with me, and continue to hold close, the stories and lives of the patients and colleagues who have taught me so very much — in this city that has inspired and pushed me. I remain wholly committed to working on their behalf. I take this step with hopes for all of us.

Priya E. Mammen is an emergency physician and public health specialist who has joined the private sector to work within a national commercial enterprise focused on health and wellness, where she will continue to advocate and innovate to decrease disparities and improve health equity.