Welcome BACK to EMpower! We’re bringing back this popular, long-dormant piece of EM Resident that focuses on leadership in emergency medicine — where we share the incredible stories of leaders in the EM community. These leaders are pioneers in the field, innovators of our specialty, and often, former EMRA members! Our hope is to inspire and empower you, the future of emergency medicine, on how to effectively navigate, advocate for, and even change our specialty.
Our first EMpower honoree is none other than Sandra Schneider, MD, FACEP. Dr. Schneider completed medical school and residency at the University of Pittsburgh and is board-certified in both internal and emergency medicine. She is a past president of ACEP, SAEM, and AACEM, past chair of the Residency Review Committee for Emergency Medicine, and past chair of the Emergency Medicine Foundation. Dr. Schneider previously was a prior professor of EM at Hofstra Northwell School of Medicine and senior research director for the North Shore/LIJ Department of Emergency Medicine. She was founding chair of the Department of EM at the University of Rochester.
Currently, Dr. Schneider is senior vice president for clinical affairs at ACEP and an adjunct professor at the University of Pittsburgh. During the COVID-19 pandemic, she led ACEP in its response to provide education and resources to emergency physicians and their patients in the United States and abroad; these resources included the COVID Field Guide and COVID EngagED discussion board. Dr. Schneider is a recipient of SAEM and AACEM leadership awards as well as ACEP’s prestigious Wiegenstein Leadership Award. Additionally, she is an honorary member of EMRA.
First things first, why emergency medicine?
I am old(er). When I graduated from medical school, there were only a couple of 1-year training programs in EM, but none accredited, and none supervised. Jobs in the ER (many were just a room or 2 so I use “ER”) did not pay well, and you needed no training to work there. I was deeply in debt from college and medical school. I needed a secure job, so I trained in internal medicine. During my 2nd and 3rd year of residency (averaging 80-100 hours a week), I would moonlight an additional 12 hours on most weekends (pay was $10 per hour). During my U.S. Public Health Service payback in rural Kentucky, I worked the ER (okay, this one had 3 rooms) on the weekends while I had my IM office M-F. I loved my ER shifts. My first job after Kentucky was as faculty at a brand new residency at Pitt and medical director of an ED at a teaching hospital! I was fortunate to grandfather into EM. EM is the greatest specialty of them all. Our patients are fascinating, every day is different, each patient is a mystery to be solved. Even if the shift is boring, there is the possibility that the unexpected will happen. We have flexibility in our schedule and in our job locations unlike any other specialty. As a mother, I was always able to trade away a day shift, so I never missed a school play or teacher conference. And we have the best stories!
If you were restarting residency, what advice would you give yourself?
Read. Read at least 2 hours every day you are off, and if possible, at least an hour on the days you work. As a first and second year, read about patients you see. Read the relevant textbook chapter, and then read the literature. Texts are 5 years out-of-date but are comprehensive. Journals are only 1 year or so out-of-date. In your final year, pick a major textbook and read the entire book cover-to-cover over the year. This will prepare you for your boards and make you a better physician. Continue to voraciously read as an attending.
Don’t be afraid of debt. Get the help you need — groceries delivered, housecleaning, nanny. You will make plenty of money later on.
What is the best career insight that you want to pass along?
There is an old biology experiment: Put a frog in boiling water and they will jump out. Put them in cold water and heat it until it is boiling and the frog will stay in the water and die. Be sure to check the “temperature” of your workplace periodically. If you find yourself in a toxic environment, there is always a way out, especially when you are an attending. You can move, live apart from your spouse or partner, or commute even long distances. There is telemedicine and work outside the ED. There was a time I found myself in a toxic environment, but I had friends and family and a beautiful home, so I stayed too long and almost boiled. I left and found a wonderful work environment, and my job here at ACEP. Keep tabs on the temperature and be ready to jump out if the water is too hot.
What keeps you coming to work every day?
The patients. I love when you ask someone, “What happened?” and they look around before answering. You know the best story is coming. And who else gets to save a life? It is tough when we lose one, but without us, all of them would be lost.
What is your best time management tip?
Use all of your time. I work on airplanes, foregoing the movie or book. My daughter took equestrian lessons (and dance, and ice skating, and a myriad others). I would bring work and ask the other mothers to alert me when my daughter was actively riding, skating, etc. When she was just standing there, I would work. I am an early riser (compared to my husband), so I often work or read while he is asleep. Have a to-do list. Put everything on that list — household, personal, and work. Find something to decompress after work so you are ready for your family. For me, classical music played VERY LOUD on the way home and on bad days, a game of solitaire made me human again.
Share 2 things that are on your desk right now.
Hot (diet) cocoa and 15 thumb drives waiting to be organized
What is the best on-shift snack?
Cashews. And I always have a Diet Coke, even when I had to hide it from The Joint Commission!
What is the most recent book you read?
American Sirens by Kevin Hazzard. This is the story of the first professional paramedics and race in the 1970s. I gave medical command to these amazing guys. I worked in Peter Safar’s lab, and Nancy Caroline was my neighbor.
What is your favorite song to hype you up before a shift?
Eye of the Tiger — especially the riff
If you were a part of EMRA or have worked with EMRA, how has that been impactful for you in your career?
Because I did not train initially in EM, I never belonged to EMRA. However, one of the greatest honors I received was honorary membership in EMRA.
— Morgan Sweere, MD, MPH, EMRA Board Secretary and EM Resident Editor-in-Chief