Dr Sally McCarthy is president of the Australasian College for Emergency Medicine and a senior staff specialist in the emergency department at Prince of Wales Hospital in Randwick, Sydney. A graduate of the University of Sydney medical school, Dr McCarthy is also medical director of the Emergency Care Institute New South Wales.
“During my residency at St Vincent’s Hospital, I enjoyed my terms in surgery, as well as in emergency medicine. At the time I was thinking I’d do surgical training. But during my resident year in 1985, my mother died of breast cancer. I took a year off and did a lot of soul-searching, and decided I really wanted to do emergency medicine. The specialty was still fairly new, so I saw that there was a lot of scope for contributing to its development.
I started off doing purely clinical work, as most doctors do. Because it was a new specialty, you could take on administrative roles at an earlier stage in your career in those days. I felt the need to try to improve things, and took on more management-type roles. After holding emergency director positions at other Sydney hospitals, I became director of the emergency department (ED) at Prince of Wales. I held this position for almost 8 years, until March 2011, when I stood down to take on the medical director role with the Emergency Care Institute.
The Emergency Care Institute is part of the Agency for Clinical Innovation and aims to improve care for patients across NSW EDs. It does that by improving communication across departments, advocating on behalf of EDs and fostering research and innovation. A key challenge that I’m trying to bring to people’s attention is the prevailing staffing structure in the ED, where there are lots of very junior staff with relatively few senior staff. That needs to change, and I think it will.
Emergency medicine probably pushes people into roles where they can change the system in some way, because the ED feels the impact of dysfunctionality in the rest of the system. You’re interacting with the whole system, so you get a good view of what works well and what doesn’t. If you look at the current Australian system, our Commonwealth Chief Medical Officer [Professor Chris Baggoley] is an emergency physician, as are several Australian Medical Association state presidents or presidents-elect, and, increasingly, hospital chief executives.
In 2000, I completed a Master of Business Administration (MBA) degree from the Australian Graduate School of Management. I was prompted to do it because I was sick of being told what to do in the hospital by people who didn’t value the insight of doctors! There was a bit of a tendency to say, ‘oh doctors can’t do management’. I think that’s false! Having an MBA gives you some legitimacy, and it gives you different frameworks in which to look at things.
I wanted to get some perspective outside the health system, so I chose to do a general MBA rather than a health management degree. It reinforced that there are some aspects of health system management that need to change substantially. I was later an alumni mentor for the business school for 6 or 7 years. I mentored students, and I’ve had management trainees do attachments with me, from health and other backgrounds.
One of my career highlights has been doing retrieval work. I enjoyed the close working relationships between all of the critical care and emergency services people. I have also enjoyed working with a variety of research groups, including people outside medicine, such as linguists and psychologists. I’ve done lots of research on the effects of access block and overcrowding. Recently, I contributed to a qualitative study on the interaction emergency clinicians have in trying to get patients accepted into the rest of the hospital, which was reviewed as a coming-of-age for qualitative research in emergency medicine.
One of the downsides of working in the ED is that emergency physicians are pushed to get patients out, so it can put you in an adversarial position with other services. I hope the national access targets will change that. In the past, I think there was a perception that anybody could work in “casualty”, but it is increasingly recognised that specialist emergency care improves patient care and system outcomes.
Being president of the College has given me the fantastic opportunity and privilege to influence the system across Australasia. I’m very interested in all the things that go into making great emergency services, and workforce, training and education are fundamental to that. Another highlight has been introducing non-specialist certificate and diploma courses for non-specialist doctors working in emergency departments across Australasia. That was something I was very keen to do.
Emergency medicine is interesting, sociable and you get to make an impact at a crisis point in patients’ lives. You interact with lots of students, and it offers great opportunities to collaborate across the system. Clinically, it’s extremely varied — you’re always seeing new things. It’s a real privilege getting to know a lot about people in a short space of time, and to often have a significant impact on their lives. It can also be a lot of fun working with a large multidisciplinary team. I’m very glad I did it.”
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