I've been a physician in Emergency Medicine for over 30 years. In 1999, I took on the added responsibility of consulting for Premera Blue Cross.

I essentially fell into emergency medicine. It started when I left a job at the Seattle VA to travel for a year. When I returned, I began working in emergency departments around Seattle, beginning with the University, then Providence and eventually Virginia Mason. Now I enjoy the patient interaction, teaching residents, and watching health care delivery deal with the pressures brought upon it.

Making an emotional connection to people who are in some degree of crisis.

The challenges have remained to stay up to date, interested, motivated and unjaded, and to remember what and who I'm really there for, particularly in an environment that has become less friendly to physicians and medical practice in general. It is also a challenge dealing with administrative fiats and trying to convince administrators (both MD and business types) that changes on paper and theoretical improvements don't always translate into better patient care.

Understanding organizational structure, the roles people play, how personalities affect effectiveness, and looking to the near and long term with respect to change.

Being able to discuss real-time, actual work-based issues in the classroom, and having the advantage of both faculty and fellow student input vis-à-vis their understanding of, and approach to, solving the problem. The varying perspectives, usually based on their own work experience, always provided keen insight into the management of daily dilemmas (and successes) of the workplace. I also enjoyed meeting fellow students and faculty, and appreciate knowing that I can always call one of the former and get whatever help I might need.

Look down the road and decide if where you are now is where you'll want to be in the future. Don't underestimate the impact you could have.