Medical Student Council President’s Message Spotlight On Leaders in Emergency Medicine: Gus Garmel, MD FAAEM

Gus Garmel, MD FAAEM

Originally Published: Common Sense, September/October 2012
Original Author: Mary Calderone, MS3
AAEM/RSA Medical Student Council President

The “Spotlight On” series re-started by Dr. Leana S. Wen, AAEM/RSA president, will be continued this year by Mary Calderone, AAEM/RSA Medical Student Council President. The “Spotlight On” series highlights interviews with leaders in emergency medicine about their experiences, perspectives, and insights. The sixth installment is a conversation with a leader in EM and AAEM, Dr. Gus Garmel. Dr. Garmel is Co-Program Director of the Stanford/Kaiser EM residency program, Medical Student Clerkship Director (Surg 313D, Stanford University School of Medicine), and senior emergency physician at Kaiser Santa Clara. Dr. Garmel has received numerous teaching awards, including both the Peter Rosen Award from AAEM and the Program Director of the Year Award from AAEM/RSA.

MC: Why did you choose emergency medicine?
Dr. Garmel: I chose EM because I enjoyed the clinical challenges that it offered, especially during its formative years as a specialty. I wanted to be in the position to help patients from all walks of life at their time of greatest need, regardless of their reasons for seeking care or their ability to pay. I still consider it an honor to be in this position.

Who has been your biggest mentor?
Dr. Garmel: My strongest mentor, without question, was and still is, Glenn Hamilton. I was his chief resident, and still communicate with him to share ideas and discuss professional successes and challenges. This mentor relationship is similar to what I try to offer our alumni, residents, and students. Glenn’s educational innovations are unparalleled. Even though I was already a capable and passionate educator, he inspired me to take these skills to the next level.

MC: How did you get to your current position?
Dr. Garmel: I moved to California in 1991 after being offered the opportunity to help direct the Stanford/Kaiser EM Residency Program at its inception, a position that ideally matched my passion and skills. The chance to be involved in administrative and educational leadership from the ground floor was incredibly exciting for me as a creative thinker and problem-solver. I was fortunate that the timing was right. I’m sure that my selection had a lot to do with the confidence my mentors had in my abilities. I also think that my passion for education is obvious to those who meet me. This position has afforded me over 21 wonderful year of active involvement in residency training, during which I’ve witnessed remarkable resident and graduate successes. Several of our graduates are residency directors around the country. Others are talented hospital administrators, researchers, academicians or community physicians. It’s rewarding to have had a significant role throughout our program’s history, which has given me so much joy.

Tell us about your involvement in AAEM.
Dr. Garmel: I first got involved with AAEM around its onset because I supported its values and mission. I’ve served AAEM as a research forum judge at the Annual Scientific Assembly (SA), initially with Peter Rosen and Bob McNamara, and given lectures at past SAs. I played a role providing AAEM membership for our entire residency program and securing the opportunity for our second-year classes to attend SA. I’ve also encouraged our residents to become AAEM officers at both state and national levels. I submitted the materials necessary to get an early AAEM Certificate of Workplace Fairness for our ED. I was proud to represent AAEM as the United States Chairperson of the Resident Education Track at MEMC V in Valencia, Spain, and also lectured at the meeting. I continue to support AAEM’s contributions to our specialty and what it does for individuals in need of its services. I am proud to be a member of AAEM and respect its strong and important voice.

What would you say to trainees and young EPs about why to get involved in AAEM?
Dr. Garmel: Our specialty needs emergency physicians to support it financially and politically with their energy and leadership, so I am a huge advocate of organized EM in general. I am a strong champion of AAEM specifically, because I think it takes the right approach to education and has the right vision about the future of EM, board certification, workplace fairness, and due process. I support AAEM’s ideals and principles. I’ve sat at the table with many of the early founding members, and it has been wonderful to see AAEM evolve and grow.

MC: How do you define a “teaching moment,” and how do you find time to integrate teaching into busy ED shifts?
Dr. Garmel: In my practice, every moment is a teaching moment. This creates challenges at times, but they are rewarding challenges. By seeing every opportunity as a teachable moment, things can be identified, debated and improved, and people can learn — whether it’s a patient, a family member, a resident, a  tudent, or me.

What has been the most defining moment in your career thus far?
Dr. Garmel: Every year, graduation day for the Stanford/Kaiser EM senior residents is a defining moment for me because of our commitment to each other over the past three years. Mentoring students, residents, and junior faculty is extremely important to me, and I was fortunate to be honored by EMRA with their mentorship award. The Peter Rosen Award and the Program Director of the Year Award that I received from AAEM and AAEM/RSA, respectively, as our program’s Co-Director are humbling distinctions, and I’m incredibly proud of these. As a clinician, every patient encounter is a defining moment for me, which keeps me focused on my responsibilities as an emergency physician.

MC: If you could give one piece of advice to interested applicants in EM, what would it be?
Dr. Garmel: I wrote something a while back titled “The 9 P’s That Program Directors Look For,” and still believe in them (performance, productivity, professionalism, personality, preparation, persistence, punctuality, passion, and potential). EM residency program directors desire individuals with passion, sensitivity, integrity and potential — potential not only from an intellectual perspective, but also for patient care, academic, research, political, and administrative activities. I consider myself a “resident motivator” because I look for ways to motivate residents (and students) to get the most out of each patient encounter. Applicants should keep their options open about future career possibilities. Even though they might think they know where they’re going, this direction may change. It’s also important that applicants, residents, and faculty challenge themselves to consistently perform at the highest level, because our patients and our specialty deserve nothing less.

Editor’s Note:
When I read this interview, I was struck by the responses to questions 4 & 5. I hope you will go back and read those again. Dr. Garmel uses phrases like “values and mission,” “ideals and principles,” and “advocate of organized EM.” He encourages his residents to seek leadership roles in AAEM and successfully applied for a Certificate of Workplace Fairness for his ED. As he puts it, “I am a strong champion of AAEM specifically, because I think it takes the right approach to education and has the right vision about the future of EM, board certification, workplace fairness, and due process.”

If you are reading this, then you too support AAEM’s values and mission. For that, I thank you. However, are you doing all you can in your daily professional life to spread those values and further that mission? Are you an active participant in AAEM? Are you trying to recruit new members? Are you encouraging your colleagues to read Common Sense and attend Academy meetings like the Scientific Assembly? Emergency physicians have been fighting for the soul of our specialty for years — to make sure it is treated as a legitimate specialty that plays by the same rules as all other specialties, to protect physicians from exploitation and other unfair treatment in the workplace, and to ensure that our rights to due process are honored. Such battles are not won simply because “the good guys always win.” The forces arrayed to remove control of the practice of medicine from physicians are greater than ever, and emergency medicine and other hospital-based specialties are the first targets of these forces. As physicians, we have an ethical obligation to make sure we are free to exercise our professional judgment in the best interest of our patients, rather than as coerced by corporations, bureaucrats, administrators, tort lawyers, etc. If we fight this battle as individuals, we will be crushed one at a time. That is why active participation in organized emergency medicine, specifically AAEM, is critical. No other organization completely shares our values or even begins to fight for them the way the Academy does. If you aren’t already, get active in AAEM, foster its growth, and become politically aware and active. As Ben Franklin warned the signers of the Declaration of Independence, “We must hang together, or assuredly we shall hang separately.” ■

Andy Walker, MD FAAEM
Editor, Common Sense