EM Collective Wisdom: Judd E. Hollander

Author: Judd E. Hollander, MD (@juddhollander, Senior Vice President for Healthcare Delivery Innovation, Thomas Jefferson University; Associate Dean for Strategic Health Initiatives, Sidney Kimmel Medical College; Professor & Vice Chair of Finance & Healthcare Enterprises, Department of Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

Is there anything else? We get to take care of patients while almost everyone else is prioritizing something else. What better privilege than to know that everyone is so confident in our ability that we can be the only physician in the whole hospital.

Seriously, when I was young, it was the diversity of the cases and the fascination with medicine. Now for me, it is really about two major things –

1. We are the specialists who still live up to the essay we wrote for medical school. We don’t walk away after hours. We stay up all night. We never turn anyone away. I have no idea if any of my patients have insurance, and I don’t care. We just provide whatever they need. Sometimes it is just a turkey sandwich… but it is the only act of kindness that person will get that day (or week).
2. The diversity of experience, both in terms of patient care venue and in terms of additional career opportunities whether it be business strategy, med mal, pharmaceutical consulting, or working with nonprofits. We see the best and worst of the health system. We see the best and worst of our colleagues, and we see opportunities to make individual patients and the whole health system better.

2) Most impactful case. 

I am an advocate for undressing the patients – it is cheap, easy, and lifesaving. One example I give my residents is the young female seen by an internal medicine resident after midnight with unimpressive midepigastric abdominal pain. No other symptoms (totally negative review of systems). The intern did not get the patient undressed. I made them go in and do that and then re-examine the patient. She found three petechiae on one ankle. No headache, fever, stiff neck. You know where this is going… We observed the patient. In one 15-minute interval she became unconscious. LP showed pus. She got steroids and antibiotics. She was walking around the floor later that afternoon. If she did not get undressed, she would have been sent home. I might still be talking about the case, but might be telling my lawyer that there was no inkling of meningitis, and feeling horrible I missed an opportunity to save a life. I wouldn’t have known. Be compulsive. Get patients fully exposed. You might just save a life.

3) Most important career decision leading to satisfaction.

When I decided to learn how to apply the skill set I developed as a researcher to the business side of medicine, I enrolled in a Wharton Exec Education program (not an MBA) and took only the classes that were NOT taught by someone in healthcare. In order to avoid “group think” I learned from outstanding educators and leaders outside of health care and went home after every class and thought about how I could apply it to healthcare. I received feedback from classmates who were corporate CEO’s and Vice Presidents of banks, pharmaceutical companies, hotels, as well as serial entrepreneurs and senior government officials from foreign countries. Interestingly, one of my early presentations was on how to develop a telemedicine program and work through change management. Two years later, when I transitioned from Penn to Jefferson that became a large part of my job.

4) What does future of EM look like?

It will not be about “emergency” medicine – it will be about being the “available-ists”. Our value to medicine has always been that we treat anyone, anywhere, anytime. We love the sickest of the sick, but they are not what we spend most of our time doing. We need to embrace the fact that our core competency, the thing that drives health systems to continue supporting EM, is that we help everyone else be successful, and we take care of patients when no one else is around or willing. To that end, we need to expand into urgent care, retail clinics and telemedicine. We need to continue to take care of people when they want to be taken care of, how they want to get the care. It is not about us, it is about them. Kodak made film, your smart phone stores memories. We take care of everyone – we need to continue to do it everywhere. Everywhere has just gotten larger than our local ED.

5) Greatest achievement / why giving back is important.

No questions asked. The greatest achievement is being able to mentor rising stars in the specialty. I won’t name names for fear of leaving someone out, but I have helped mentor people who have gone on to be Presidents of SAEM, members of journal editorial boards, chair departments, lead federal agencies, sit on federal study sections, get federal funding, run clinical trials, create new knowledge, and change the future of health care. Although we all love caring for one patient at a time, it is the ability to train future leaders and researchers that allows me to believe that one of them might actually change the world, and I might just have played some small role in helping them along the way.

6) Favorite failure.

Every pre-existing advertised job I have applied for, I did not get. That includes a chair position and an editor-in-chief position. That enabled me to craft my own vision for my own job and find an employer who saw merit in my vision. I moved to Jefferson in 2014 to embrace a role as Associate Dean for Strategic Health Initiatives and now enterprise wide Senior Vice President of Healthcare Delivery Innovation. In those roles, I started Jefferson Urgent Care (now 7 sites) and the JeffConnect enterprise telemedicine program which now has over 1,000 providers taking care of patients when and where the patients want the care.

7) One thing you would change about our field.

I would create EMTALA that includes inpatient services and places physicians refusing to do consults or take admissions on the medical record… how much would that help us and our patients?

8) Something that you love that has indirectly impacted your EM career.

I am going to give the shout to my parents, Maxine and Bruce Hollander, who taught me that despite being the smallest kid in the class, I could be the best at something. My father, a football player in his early life, tried getting me to be a field goal kicker. It didn’t exactly work out, but the push that instilled in me to excel in something, anything, carried me through my life and my career. I have combined the lessons learned from my parents with those learned from my wife, Jeanne, and we are fortunate to have two very successful adult children (Greg and David), a large network of family and friends, and a very cuddly golden doodle named Cody. The combination of all this support allows me to work hard, play hard, and feel fulfilled.

3 people you’d like to see fill this out

1) Deb Houry

2) Richard Zane

3) Brendan Carr