Yes, this is a piece on observation medicine as the expansion of our specialty. My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or creed. I learned to stabilize, evaluate and treat then admit or discharge. Clearly, I’m simplifying though, historically, our disposition decision was binary, patient in or out.
Then overtime as I practiced emergency medicine (EM) and grew in my career, I became exposed to the business side. The business side is complex and includes payors, contracts, utilization reviews, denials, audits, and the often thin margin between making versus losing money for a hospital and healthcare system.
So how did this become my world? Well, I was given a unique opportunity to start an EM-run observation unit two years after finishing residency. This was a risk for me as I had no formal background as to what observation even was and I was still “young” in my career. At that time, I was a new mom, newish wife, relocating to a new city. Perhaps because of all the change and ‘newness’ around me, the entrepreneurial bone in my body asked, why not? I would also like to give credit here to meeting an exceptional mentor who was supportive of me, and she also exuded a ‘why not’ attitude.
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