by Will Sanderson, Danny Cuevas, Rob Rogers
Imagine walking into the hospital to start your day – ambulances are blaring, the waiting room is clamoring, babies are crying. You stroll through this sea of humanity and eventually arrive at your workstation. After setting your bag down, you prepare the basic tools of your trade: a stethoscope, a fresh cup of coffee, and a sharp mind. Taking a deep breath, you prepare for the routine of yet another shift. But there is no “routine.” There is only the excitement and variety of what is about to come through those sliding double doors. That flimsy piece of metal and glass is the only barrier that separates you from the thousands of people with a multitude of medical ailments, any one of which could bring them to your doorstep. With a low hum and an almost silent whoosh, these doors part to reveal your next patient. To them, it is probably the worst day of their life. For you, it’s another Tuesday.
Who will be your next patient? Is it the 4-year-old boy with the asthma attack gasping for that next breath? Will it be the 78-year-old widower who fell at home while fixing himself a sandwich? Maybe it’s the 31-year-old female who just rear-ended another vehicle at highway speed; oh, did they also mention she’s 28 weeks pregnant? You look over and see new patients filling the critical examination rooms and the trauma bay. No matter what walks through that door, you’ll be ready. You sit down. You grab a chart. It’s time to get to work. Today is going to be another routinely awesome day.
Why choose a career in emergency medicine? Before discussing where the field is going, it’s important to know a little background on where it has been. And if you’re reading this and considering a career in EM, do yourself a favor – take the time to watch this documentary from the Emergency Medicine Residents’ Association (EMRA). As you’ll see, the specialty of emergency medicine has evolved drastically over the last several decades and continues to be an increasingly popular choice among graduating medical students. Only a few decades ago, emergency departments around the country were staffed by physicians with a variety of training backgrounds. The vast majority of these physicians had little to no emergency medicine training at all. General surgeons, family physicians, neurologists, and even psychiatrists were among those that staffed emergency departments around the country and throughout the world. But since the establishment of the first emergency medicine residency programs in the 1970’s and the subsequent establishment of the American Board of Emergency Medicine in 1979, the specialty has continued its rapid development in defining its place in the house of medicine. Walk into anything other than the smallest of EDs these days and you’re likely to encounter an emergency medicine residency trained physician. A study published in 2008 demonstrated that in its relatively short history as a recognized medical specialty, the number of physicians staffing departments across the country who had received emergency medicine training soared from 0% to 70%. Why the dramatic shift? To understand the answer to this question, you need to take a deeper look into the practice and lifestyle of the modern emergency medicine physician.
Emergency medicine is a fast paced, team oriented, dynamic specialty that focuses on the rapid evaluation and treatment of a diversified patient population consisting of both pediatric and adult patients. As the initial provider for many of their patients, the emergency medicine physician is charged with the rapid assessment and data gathering needed to launch the initial workup and management of a wide variety of complaints that bring patients to the ED. Their work has an incredible influence in the patients’ care as it generates the driving force for further medical evaluation; whether the patient is admitted to the hospital or discharged home, the emergency physician plays a huge role in directing both short and long term care well after their stay in the emergency department. Here’s a look inside the lives of several emergency physicians from Rob Orman of ERcast. Variety is the spice of the EM life. There is no set routine or expected patient list for the day. In the short span of a shift, you may diagnose strep pharyngitis, intubate an unresponsive patient who overdosed on heroin, reveal a cancer diagnosis to a young patient with flu-like symptoms, reduce a dislocated hip, place a chest tube in a patient with a hemothorax, and resuscitate a patient undergoing a cardiac arrest. Your next patient could be a six-year-old or a 75-year-old, both with abdominal pain. In a setting where some may see chaos, EM physicians find order. It’s exciting. It’s energizing. This diversity is a uniquely challenging aspect of the medicine practiced in the emergency department.
EM physicians pull from a knowledge base that spans all medical specialties including pulmonology, cardiology, gastroenterology, trauma surgery, nephrology, ophthalmology, psychiatry, and neurology. Jack of all trades? Sure. Master of none? Not even close. The gap between the medical and surgical specialties is bridged within the practice of emergency medicine. The combination of a broad knowledge base with the need to develop a focused procedural skill set makes the EM physician a veritable Swiss Army Knife within the house of medicine. From endotracheal intubation, cricothyroidotomy, fracture reduction, and central line placement to pericardiocentesis, thoracotomy, chest tube placement, and lateral canthotomy, even the most enthusiastic proceduralist will find his hands full working in the ED.
Variety is a word that not only defines the practice of emergency medicine but also the lifestyle it affords. Are you a morning person who is up at the break of dawn and thinks best with a fresh mind after breakfast? Or are you a night owl who gets a burst of energy in the wee hours of the night when most others are sound asleep? Are you a weekend warrior who prefers to keep your schedule open on those days? Or would you rather work during the day to finish in time to pick up your children after they finish their day at school? Irrespective of your preference, the shift work in the emergency department affords a level of flexibility not seen in other medical specialties. Emergency physicians manage the hustle and bustle of their department for a set number of hours, after which a fresh physician team arrives to take over. After his shift, the previous doctor hands over the care of his patients to the oncoming team to continue with the diagnostic and therapeutic management of the patient. In this regard, one can wrap up, sign out, and head home without bringing any of his work with him. The nature of shift work also allows for trading of shifts amongst the physicians staffing the department. Want a week off in April to spend some time at the beach? As long as you plan in advance, you shouldn’t have any trouble getting there. With enough planning, it’s quite possible to be at nearly every important life/family event you choose.
Within the field of emergency medicine, physicians are employed in several settings. These settings range from hospital-based and freestanding emergency departments, urgent care facilities, observation medicine units, emergency medical response services, and even telemedicine locations. Patient volumes, even at facilities in close proximity to one another, can vary greatly. Some facilities are designated trauma centers while others are not. There are facilities teamed up with a strong academic center to provide numerous subspecialty support and others are resource-limited community hospitals. No matter what your preference, there are a variety of settings to fit your needs. But let’s get to the real question at hand: are emergency medicine physicians satisfied with their career? This is really the crux of any discussion regarding career choice. How devastating would it be to realize after spending over a decade in college, medical school, and residency that working in the emergency department isn’t for you? Well, in 2015, emergency medicine physicians came in 4th in overall career satisfaction compared to other medical specialties. 60% of all emergency physicians surveyed were satisfied with their income. Emergency physicians typically work more intensely for fewer total hours compared with other physicians and enjoy above-average compensation per hour. Below, Dr. Kevin King of the University of Texas Health Science Center San Antonio discusses the Pros and Cons of a Career in Emergency Medicine: Pros and Cons of a Career in Emergency Medicine. As you can see, the life of an emergency medicine physician is not a perfect fit for everyone. EM physicians suffer from relatively high rates of burnout. However, as the field evolves and physician wellness becomes a priority for all physicians within medicine, this will surely improve. If the characteristics outlined above are consistent with the qualities you are looking for in a specialty, emergency medicine may well be the perfect fit for you.