EM Collective Wisdom: James M. Dahle

Author: James M. Dahle, MD (@WCInvestor, EM Attending Physician, Utah Emergency Specialists) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

I love being able to help people on the worst day of their life. EVERYONE has an “ER Story” about when they or their family member was in the ED. They remember every detail. I like being part of that impactful day.

2) Most impactful case. 

I remember a STEMI patient who kept going into v-fib. He could feel it coming and after the 10^thtime it happened, the nurse was just shocking him back before he even lost consciousness. He was not very happy about it but knew it was keeping him alive. He did great once stented, but nothing but electricity was working until then!

3) Most important career decision leading to satisfaction.

The decision to join a small democratic group, where I had a say on how we ran our business, scheduled ourselves, paid ourselves, and hired our coworkers. I’m not always on the winning side of the vote, but I know I’ve always got a vote.

4) What does future of EM look like?

While some fields like radiology have to worry about being outsourced to India, we’re not going anywhere. I feel blessed to have been able to practice in the “golden age” of EM. Lots of docs talk about how things used to be so much better 10 or 20 years ago. There has never been a better time to be an EP. We’ve never been paid so well. We’ve never had such a wide scope of practice and so much opportunity. We’ve never had so many excellent ways to learn and keep up. I can’t believe my second choice in medical school was OB/GYN; I would have been miserable.

5) Greatest achievement / why giving back is important.

Warren Buffett says the greatest measurement of success is the percentage of people that you want to love you that actually love you. I consider my greatest success to be my 19 year marriage and the fact that none of my kids hate me. Giving time and money back to the profession, my community, and the world in general is critical. We try to pay our success forward because if not us, who? Through The White Coat Investor, Katie and I have established a scholarship program for medical students that will give out over $60,000 in cash and prizes this year.

6) Favorite failure.

I spent a great deal of time while in the military learning to assemble and run a tent surgical hospital. We were deployed to Chile to construct it and hand it over to the local docs after their big earthquake in 2010 to use until their hospital was rebuilt. They took one look at it and decided to just drive 50 miles down the road and use that hospital instead. Like a lot of what happens in the military, it felt like a pretty big waste of resources.

7) One thing you would change about our field.

I would like to see every doc who wants to be an owner in a group be able to do that in any area of the country they would prefer to practice in. The rise of the CMG has meant that there are entire swaths of the country where small democratic groups have ceased to exist and may never return.

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

I enjoy teaching doctors about personal finance and investing. Unfortunately, The White Coat Investor became so big that despite hiring help, I had to cut my clinical time back to ½ time to maintain sanity. In some ways, it has been too successful and it no longer makes sense from a financial and medicolegal standpoint to keep practicing EM, but I plan to keep doing it anyway!

3 people you’d like to see fill this out

1) Christian Fox

2) Ken Iserson

3) Jeff Nielson