Emergency Room Physician Harnesses the Power of the Popular Press

Renee Hsia, MD, MSC, researches the impact of emergency department closures on underserved groups

When Renee Hsia was still in college, she was pretty sure she would become a doctor. But a six-month stay in South Africa changed her idea of what she wanted to do as a physician.

“As someone who had long wanted to become a physician, I had thought that individual intervention was most important,” said Hsia, who is an associate professor in the department of emergency medicine at the University of California, San Francisco. “South Africa changed the way I saw my role. Injustice is based not on one person treating another individual poorly, but it is built on a scaffolding that creates and maintains these disparities. It made me interested in looking at disparities on a systems level [in health care].”

After her training, she chose to work as an emergency department physician at San Francisco General Hospital, the safety-net hospital for the area. Because her division was mainly a clinical program at the time she began, however, there were few research colleagues with whom she could collaborate on these issues. Hsia, however, found a group of like-minded peers in the Robert Wood Johnson Foundation Physician Faculty Scholars program. The three-year career development award, which Hsia received in 2009, gave her the salary support and time she needed to focus her research on the broader systematic issues that she felt were vital to the health of the patients she saw every day.

RWJF Physician Faculty Scholars, which ran from 2006 through November 2012, sought to strengthen junior medical faculty’s leadership skills and academic productivity. Scholars received funds for a three-year research project, along with mentoring, networking, and other supports. Read the Program Results Report for more information on the program.

“One of the things that appealed to me about Physician Faculty Scholars is that it connects you to a network of people who are very willing to help you and tell you which of your ideas are good and, equally important, which are not,” Hsia said. “Another thing that this program provided was credibility in my department. Unlike traditional specialties such as internal medicine, there are relatively few health services researchers in emergency medicine. Because UCSF could only nominate one applicant in the national competition, it reflected well upon the Department of Emergency Medicine.”

Going beyond JAMA to reach policy-makers. For her research project, Hsia studied the impact of emergency department and trauma center closures on underserved populations. She found that hospital emergency rooms, especially those that serve people who are poor in urban areas, were closing at an alarming rate. Nearly one-third of hospital emergency departments in urban and suburban areas closed between 1990 and 2009.

During the same time period, emergency department visits increased by more than 30 percent, with visits by publicly insured and uninsured patients increasing at an even faster pace.

“Areas that are poor, or [whose residents] have poor health insurance, have systematically less access to emergency departments,” Hsia said. “It’s important to give empirical evidence that this is having an effect. Our health system has structural inequities that are difficult to identify at first glance.”

Crowding in emergency departments also impacts patient outcomes, Hsia found while conducting a related study of hospital emergency departments in four California counties. “We found that for patients who have a heart attack, the 30-day mortality if admitted on a very busy day was 22 percent higher than if admitted on a non-busy day,” Hsia said. “That’s a pretty big difference. And that takes into account the baseline mortality rates of the hospitals.”

The Journal of the American Medical Association published Jha’s two studies—the first in the May 18, 2011, issue and the second in the June 15, 2011, issue. Seeing your work published in such a prestigious journal would typically be enough for many young researchers. But Hsia had learned through Physician Faculty Scholars that if she wanted to see real policy impact from her work, she needed to learn how to effectively communicate with to the mainstream press. As part of the support Hsia and other scholars received, the communications firm IQ Solutions offered assistance and coaching in getting articles about her research placed in mainstream news outlets.

As a result, Hsia’s work was covered by several news outlets, including the New York Times and USA Today. In all, Hsia published 25 manuscripts on her research findings, which have been cited in the print and broadcast media more than 200 times.

“As academicians, there seems to be an unspoken message to stay away from the media and that they are less ‘scientifically pure’ than research journals,” Hsia noted. “But for me, the point is not to just publish an article for it to sit in a journal that few will read, but that you make those findings available to people who make a difference in changing health care.”

“Policy-makers read the New York Times and learn about these types of research through those outlets. This is the final piece of research dissemination to the public, and it’s the most important link. RWJF helped us to make our research better and then take it through to the last step to disseminate that research to make a difference.”

Hsia continues her research on the impact of emergency department closures, in part through a collaboration with another Physician Faculty Scholars program participant, Marie Crandall, MD, MPH, a surgeon at Northwestern Memorial Hospital in Chicago, another safety-net hospital. Crandall has a similar interest in looking at disparities in trauma care.

“A lot of times you go to meetings and [meet people] and say ‘we should work on something,’ but it’s haphazard,” Hsia said. “There was something about being within this network that was unique....There was a very personal feel to it. People checked in on you. There were enough structured things like webinars and trainings that kept us connected.”

Together, Hsia and Crandall have collaborated on studying where patients go for care when a trauma center closes in their neighborhood.

At the 2012 American Public Health Association conference, Crandall and Hsia presented findings from research they conducted on the effect of the closure of the Martin Luther King Hospital in South Los Angeles, which was the principal trauma center in the area. They found that during and after the closure, nearby trauma centers experienced a dramatic increase in trauma patient volumes, particularly for gunshot wounds. “One hospital had a huge surge in admissions. They received 40 percent of the patients,” Hsia said. “But the good news was that Los Angeles County did a good job of preparing for it.”

RWJF perspective. Because many scholars are still early in their careers, it may be too soon to judge the real impact of RWJF Physician Faculty Scholars. However, several scholars currently hold leadership positions in academic medical centers, in local, state, and federal government, and conduct innovative research projects with the potential to affect health and health care.

“The Physician Faculty Scholars program developed a cadre of physicians—65 in total—who will or who have become productive, creative, and influential physician researchers and leaders,” said RWJF Senior Program Officer David M. Krol, MD, MPH. “It also filled a niche for some physicians who wanted to pursue research that would likely not have been funded by other sources.”

For Hsia, the program helped to smooth the path she started on in South Africa to address systemic barriers in health care.

“The credibility for me was really important at that time, in a field where health services research is not very mature and people did not have a good understanding of its potential contribution,” she said. “And it provided a mechanism for me to pursue the research I wanted to do.”

Renee Hsia, MD, MSC

Renee Hsia, MD, MSC
RWJF Physician Faculty Scholar

#RWJF Physician Faculty Scholar uncovers what happens when 1/3 of emergency departments close across U.S.

“As academicians, we are trained to stay away from the media at all times,” said Renee Hsia, MD, MSC, “But I’ve realized that the point in research is to make findings available to people who make a difference in changing health care.”

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