Emergency Medicine

So, in case you haven't heard, I'm applying to an Emergency Medicine residency. Unfortunately, that means we'll have to move to another town, but we are trusting the Lord with the next step. Currently, I'm in the process of interviewing for residency programs. We'll find out where we're going on Match Day (March 20th) and then graduation will be May 30th. Likely we'll move soon after graduation.

Recently I wrote an essay for an Emergency Medicine (EM) publication. It takes a brief look at possible careers in EM. I've placed it below in smaller type in case you are interested.

Career Opportunities in Emergency Medicine

So you want to be an Emergency Medicine physician? Excellent! But what does that mean on a day to day basis? What if you get tired working in an emergency room? When you get older, will you burn out and have to sell used cars? Though Emergency Medicine (EM) is a relatively new specialty, most of our medical student colleagues and maybe even some of us who are applying to EM residencies, have a limited vision of the field. For our own benefit and our friends’ education, let us examine opportunities afforded us by a career in Emergency Medicine.

First, there’s the whole idea of a fellowship. Though financial incentives may exist, motivation to pursue a fellowship largely comes from a genuine interest in the specific area or advantages a fellowship can provide in academic practice. While an entire article could be written to examine the advantages or disadvantages, the five Emergency Medicine fellowships formally recognized by the American Board of Emergency Medicine (ABEM) include hospice/palliative care (a new addition), medical toxicology, undersea and hyperbaric medicine, pediatric emergency medicine, and non-orthopedic sports medicine. I recently spoke with an EM resident at the University of Alabama in Birmingham who stated his goal was a fellowship in hyperbaric medicine. However, this was only a stepping stone to his final career plan – being the physician on a small island in the Caribbean where he would then divide his time between working in an urgent care clinic or emergency room and diving among the tropical sea life. For more information on these, see the “Subspecialty Certification” tab on ABEM’s website (www.abem.org/public). If formal training is not a requirement for your academic program or personal satisfaction, additional training is available in EMS/pre-hospital medicine, ultrasound, disaster medicine (typically associated with a Master’s in Public Health - MPH), international EM (may also require a MPH), and trauma/critical care, environmental health, and administration just to name a few.

Academic practice is a career option for some students pursuing Emergency Medicine. Although academic physicians comprise only ten to fifteen percent of total EM physicians, residents coming out of an university setting may enjoy the challenge and decide to stay on as faculty. Academic positions may emphasize research or clinical teaching, but there are considerations about private versus academic practice. A study performed in 1999 showed what we would expect - salaries in academic practice are, on the average, lower than those of EM physicians in private practice. Additionally, academic attending physicians face time commitments devoted to teaching, research and often administrative duties. While these drawbacks may seem prohibitive, thankfully many EM residents do choose academic practices. They often cite interactions with residents (and yes, even medical students) as the most rewarding aspect of their job. They tend to be continually motivated by their opportunity to influence, train and mentor future generations of EM physicians. Earlier this week I talked to an EM resident about his desire to potentially stay on as faculty at the university where he is currently completing residency. His eyes almost got distantly glassy as he talked with enthusiasm about all the changes he would like to make to the medical student curriculum and how he would work to make the program a regional leader within the next five years. Though the academic physician may work longer hours overall, he/she tends to have greater diversity in his/her work activities, thus increasing career longevity. Additionally, the opportunity to complete research projects and publish in a university setting, often with university funding, motivates some EM doctors to stay in academics.

For those of us who are thrill seekers, extreme ADHDers, or non-traditionalists, there are many novel approaches to a career in Emergency Medicine. Since EM physicians are specialists trained in resuscitation and acute illnesses, certain opportunities are uniquely suited for us. For example, take wilderness medicine. Who better than an EM trained physician to have by your side on that crazy hike-through-the-jungle, live-off-the-weird-plants, canoe the-Amazon, get-bitten-by-the-poisonous-snake, escape-by-jeep-through-a-malaria-infested-swamp trip you’ve always wanted to take? Or try cruise ship medicine. Someone has an MI while dancing the night away? No problem; the emergency medicine physician on call is trained for a situation like this. Travel medicine or international medicine is something EM physicians can pursue easily through a multitude of missionary organizations or humanitarian groups such as the International Red Cross, Doctors Without Borders (Médecine Sans Frontières), or the International Medical Corp (IMC). If leaving the country is not your “cup of tea”, there’s plenty of work to be done here. Entrepreneurial ventures abound as EM physicians get more involved in hospital administration, occupational medicine for industry or large corporations, insurance company billing, telemedicine (phone consultation for a fee usually associated with a university), bioterrorism response preparation, and even medical forensics.

Finally, there’s the “plain” emergency room physician. It’s what we all truly envision when we think of a career in EM – working tirelessly in the endless cacophony that is emergency medicine – stabilizing trauma patients, reassuring a child’s parents, breaking bad news to an anxious family, setting a fractured arm, treating pneumonia, admitting the elderly patient – all in the first few hours of a shift’s time. For many of us, this will be our decision – to become the gatekeeper of the hospital.
The career options in Emergency Medicine are diverse. Many EM applicants are motivated, out-of-the-box thinkers who pursue diversity and variety, not only within the practice of medicine on a daily basis, but also longitudinally in the career of medicine. It is not uncommon for a physician to begin in one of the categories which we’ve reviewed and end up in another. That’s the beauty of a career in Emergency Medicine – constant flexibility, guaranteed diversity, and endless possibility. Can you imagine doing anything else?

-By Caleb J. Trent (significant source – AAEM’s Rules of the Road for Medical Students)