Choosing the Emergency Medicine As A Career

by C. James Holliman

The specialty of Emergency Medicine (EM) is a great career choice for medical students and interns.  In August 2013, I celebrated my 30th year in full-time EM clinical practice, and I remain very happy and satisfied with my career choice.  I have served as a career advisor to medical students and interns for over 30 years now and am very interested in encouraging people to undertake EM as a career.

Why is EM a great career? The main summary reason is that it is challenging and very personally rewarding. You can directly and quickly see the benefits and positive results of your diagnosis and treatment of patients who have emergent medical conditions. You have the satisfaction of knowing you have made a big positive difference in patients’ lives and well-being.  EM encompasses a very wide variety of patients and medical and surgical problems. EM deals with patients of both genders and all ages. The variety of cases seen by EM is probably greater than that of any other specialty, and this aspect is part of what makes EM so interesting and stimulating. The practice of EM encompasses a nice mix of diagnostic medicine and of performing diagnostic and therapeutic procedures.  The EM practitioner sees patients with undifferentiated symptoms and so must make the initial diagnosis of many conditions. EM interacts with all the other medical specialties, and at most hospitals accounts for the majority of hospital admissions.

Unique subjects routinely taught in EM include: cost-effective ancillary test ordering, efficiency in patient flow, managing multiple simultaneous patients, coordinating Prehospital and Emergency Department (ED) care, focusing the approach to medical problems, speed and efficiency of patient evaluations, efficient use of ancillary personnel, efficient recording and transmittal of clinical data, and injury and violence prevention. EM is also a young, vibrant specialty with a lot of enthusiastic practitioners, most of whom have extended interests and talents outside of medical practice, and who serve as role models and mentors.

EM also encompasses the supervision of and interactions with prehospital care. EM receives patients brought to the hospital ED by ambulance. EM is responsible for training the prehospital personnel, and in some countries, EM practitioners may find themselves directly staff ambulances, both ground and aeromedical. EM also is the main specialty involved in the planning for, and management of disasters and mass casualty situations, both of which also require close interaction with prehospital care.

EM has well-developed residency training programs for medical school graduates in many countries. The length of these training programs varies from country to country but generally is three to five years. The EM residencies each have some clinical rotations on other services or specialties (such as anesthesia, surgery, intensive care, pediatrics, obstetrics, internal medicine, cardiology, trauma, etc.), and this direct exposure to other multiple specialties makes EM residencies more interesting. Of course, the majority of time in most EM residencies is spent in the hospital ED.   Most EM residencies also offer opportunities to participate in prehospital care and EM research.  One validation of the strength of EM as a career is that in the U.S. each year it is the first or second most popular choice for residency by medical students, and the overall residency program “fill” rate in the National Residency Matching Program is over 99%. For more information on EM residencies from the perspective of EM residents, check the website www.emra.org.

EM has also developed a number of sub-specialties which enhance the career options in EM.  Each sub-specialty offers post-residency fellowship training programs of one to three years duration. In the U.S.A., the following EM subspecialties are officially recognized and have their own sub-specialty exam certification: Pediatric EM, Toxicology, Critical Care, Sports Medicine, Hyperbaric Medicine, Emergency Medical Services, and Palliative Care.  Additional EM sub-specialty fellowship programs include International EM (or Global Health), Ultrasound, Research, Education, Simulation Training, Aeromedical, Disaster, Trauma, Administration, and Information Technology. Check the website www.saem.org for the most up to date listing of EM fellowship programs.

One of the greatest assets of EM as a career is the wide variety of post-residency career choices or options.  These include practicing in a variety of hospital types: university, teaching, community, government, military, etc.  EM physicians can also practice in “freestanding” ED’s (not directly connected to a hospital) or in urgent care centers.  If a person does not want to practice at just one hospital, there is the option to undertake “locum tenens” practice in which the person works clinical shifts at multiple different facilities. For those in the military or interested in a military career, EM has been shown to be one of the most needed specialties in the military.  EM physicians can undertake leadership positions in hospital administration, prehospital care, and in the government developing and directing health policy.

Unique advantages of EM as a career include the almost unlimited opportunities in international EM development, control over and predictability of one’s work schedule, usually not having to be “on-call” when not directly on duty, and having “geographic flexibility” in the variety of places to practice. There are also a relatively small number of EM physicians in academic practice, so it is often easy for physicians interested in an academic career to rapidly advance up the “academic ladder”.

Another positive aspect for EM is that in most countries it is projected to be an undersupplied specialty for many years, and so there will continue to be many open job opportunities in EM.  EM has also been shown to be a critical component of any national healthcare system, and there is extensive medical literature support for the value and efficacy of EM.

Another nice EM career aspect is the opportunity after residency or fellowship to participate in one or more of the EM specialty state, national, regional, or international organizations.  Most countries have a national EM organization which carries out some activities including annual educational conferences.  The International Federation for EM (IFEM) has a large number of committees, task forces, and special interest groups which are carrying out a wide variety of projects which need more individuals to participate and contribute (check www.ifem.cc for more information on IFEM).  Becoming involved with one or more of the EM specialty organizations can provide one with career satisfaction in helping improve and develop the specialty as well as obtaining leadership training and experience.

So in summary, EM is a great career choice with a very wide range of post-residency work options, a very safe job market for the future, and the personal satisfaction of knowing one’s work directly and quickly helps patients, and that one’s work is a critical component of the national healthcare system.

References and Further Reading

  1. Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L, Anderson PD, Clem K. The efficacy and value of emergency medicine: a supportive literature review. International journal of emergency medicine. 2011,22;4(1):44.
  2. Mark Reiter. Emergency Medicine: The Good, the Bad, and the Ugly. http://www.medscape.com/viewarticle/750482

 

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