Emergency Medicine at Northwestern University
Emergency Medicine (EM) has had a presence at Northwestern University Medical School (NUMS), now the Feinberg School of Medicine (FSM), from almost the beginning of the specialty. The administrators of the member hospitals recognized early that a clinically sound and well-run emergency department (ED) was required, and they were willing to put their money and efforts into developing the ED. The first of the McGaw Medical Center affiliates to accomplish this was Evanston Hospital (EH), now Evanston Northwestern Healthcare (ENH), followed closely by Northwestern Memorial Hospital (NMH).
The Evanston Experience: In 1972, Dr. R. R. Hannas joined the staff at ENH to establish EM as a clinical area and to develop a residency. His efforts resulted in the third such residency in the country after the University of Cincinnati and the University of Chicago. In July of 1973, Don Cohen, MD, became the first resident of this program. The Evanston Program consisted of two years of training in EM following internship. Approval for this program was sought and received from the Liaison Residency Review Committee (LRRC) for EM. This was the official mechanism of approval at the time, as EM was not yet recognized as a separate and independent specialty. Dr. Hannas left Evanston in 1975, and Dr. Cohen succeeded him as Medical Director, serving in that role until 1980. At that time, EM was transferred from the Department of Surgery to the Department of Medicine, and Dr. Nick Pullos became the Medical Director. Sadly, Dr. Pullos died from Hodgkin’s Disease in 1981. Although his tenure was short, his contributions to the development of this specialty within NUMS were great, and he is fondly remembered by those who knew him. Dr. Pullos was followed by Jeff Graf, MD. Dr. Graff has remained the Medical Director of Emergency Services at ENH until the present.
The Northwestern Memorial Experience: NMH came into existence in 1970 when Chicago Wesley Memorial Hospital and Passavant Hospital agreed to merge their respective training programs under the aegis of NUMS and the McGaw Medical Center. This was followed by the merger of the administration of the hospitals into one structure, and the more gradual and difficult task of joining the medical staffs into one. Both medical staffs continued to demand their own OR, ICU, and ED. To attempt to resolve these issues, at least in the ED, David Everhart, who was the chief administrator of NMH at the time, hired Bernard Feldman, MD, in 1974 as the first Medical Director for Emergency Services at NMH. Initially the Program was under the Department of Surgery. In late 1974, Dr. Feldman hired three full time physicians to staff the ED. These were Peter Fried, MD, Robert Tetik, MD, and James Mathews, MD. Dr. Feldman had also brought on board Herb Wigder, MD, to do a one-year fellowship in EM. In January 1975, NMH was designated as the first Emergency Medical Services (EMS) base station within Chicago, and the Chicago EMS System was begun with five ambulances. Dr. Tetik was designated as the first Project Medical Director. Dr. Feldman and Dr. Mathews began the process of establishing a residency in EM, and worked to develop plans for an expanded ED within the Wesley Pavilion. In early 1976, construction was completed and the Passavant ED was finally closed. This made ED clinical life much easier, as medical care would now be rendered in only one facility. Prior to the expanded facility in Wesley, patient volume had been approximately 20,000 visits per year at both facilities. Within one year of operation, volume rose to 28,000 plus, and the clinical area was bursting at the seams. Annual volumes have risen every year since, except for two years in the mid-nineties, and managing these volumes has been a constant problem for ED leadership.
In late 1976, EM at NMH suffered a major blow when Dr. Feldman, Dr. Fried, Dr. Tetik, and Dr. Wigder all left NMH and joined the staff at Christ Hospital in Oak Lawn, Illinois, to establish EM at that institution. There departure led to the transfer of EM at NMH from General Surgery to the Department of Medicine (DOM). During this period, Dr. Mathews was asked by Dr. Roy Patterson, Chairman of Medicine, to take over the leadership of EM at NMH. EM was to be designated as a Program under the Division of General Medicine. After several months it became apparent that EM needed more independence, and the Division of Emergency Medicine within the DOM was established in 1977. With newly found division rank and stature, Dr. Mathews was appointed EMs first Division Chief, and remained in that position until 1998. Dr. Mathews was succeeded by Steve Adams, MD, and subsequently by Dr. James G. Adams in 2000. Under Dr. James Adams’ guidance, the ongoing efforts of over 10 years finally reached fruition when EM was established as a full department within the medical school in 2004.
Establishing a Residency Program: As EM was rapidly progressing in the clinical arena two interns were recruited for the 1977 program year. These were Norm Yanofsky and Bill Lauth, both completing a medicine internship. However, hope for an early establishment of an approved EM residency at NMH was fading. The problem was that all programs at NMH had to be a NUMS sponsored program. To obtain this, a residency program had to take the graduate of the program to eligibility for board certification. As EM was not yet a recognized specialty, it did not have a board exam. Therefore, a different approach was needed to start an approved EM training program at NMH.
Dual boarding was the one route available, and the obvious choice was to provide a program that would lead to eligibility in Internal Medicine (IM) and provide training in EM that would meet the requirements of the LRRC. The transfer of EM to IM expedited the feasibility of such a program, and in 1977 the Division of Emergency Medicine began to recruit for interns. Dr. Steve Adams became the first resident of the four-year combined residency in Emergency Medicine and Internal Medicine. The program grew rapidly, and in 1980 the Evanston program was merged into the NMH program and the preceding two-year program at ENH was phased out, graduating its last trainees in 1983. Several years’ later, dual boarding was dropped, and the current four-year EM program was established. There have been many adjustments over the years but this is basically the program that exists today.
Then and Now: EM has enjoyed a rich history at Northwestern. The division/department has always been active in the affairs of the local institutions and on a regional and national basis. Over 250 residents have completed the various programs listed above. They have gone on to excellent careers. Highlights of our history include the early establishment of a successful residency at EH, the merger of the residencies into a center-wide program, the designation of NMH as the first Resource Hospital within the City of Chicago, and our designation as one of the Level 1 Trauma Centers. More recently, the strengthening of the research program, the establishment of the EM rotation as a mandatory rotation for all FSM students, and the designation as a Department within the medical school have further enhanced our academic role and prestige. These events only occurred because of the hard work and commitment of our faculty with the support of our administration.