Emergency Medicine

ED Wall I was a patient transporter for awhile, and the Emergency Department (ED) was my favorite place to work in the hospital. This post is all about my future (knock on wood) specialty.  In 1966, the National Academy of Sciences published the "Accidental Death and Disability, the Neglected Disease of Modern Society," more commonly known as The White Paper. This influential report highlighted the poor state of emergency care in the United States. Shortly thereafter the American College of Emergency Physicians (ACEP) was established with Dr. John Wiegenstein as the acting president. The ACEP worked to create a new specialty, along with a dedicated residency program...the idea for Emergency Medicine (EM) was born.

An educational program was developed including training material with the goal of attaining specialty board status and recognition. It seems simple now, but the idea that EM should be practiced by board-certified EM physicians was a foreign concept just 30 years ago. In the late 60's, Dr. Herbert Flessa applied to the AMA to start a new residency program (which interestingly fell under a family medicine residency) at the University of Cincinnati. A little trivia factoid for you: Dr. Bruce Janiak was the very first EM resident at Cincinnati in 1970.

Way back in the 1970s, the Los Angeles County, University of Southern California (LAC/USC) Medical Center was getting over 1,000 emergency visits per day. Something had to change, and the hospital came up with a great answer. They decided to create the very first Department of Emergency Medicine, and Dr. Gail Anderson was appointed chairman.

Since then, EM has come a long way. It is its own recognized medical specialty. EM residencies are 3 or 4 years in length, and there are over 150 different programs in the United States. Now there are even 1-2 year fellowships available for sub-specialization. These include: hospice/palliative medicine, medical toxicology, pediatric EM, sports medicine, hyperbaric medicine, and more.

One of my favorite aspects about EM is that it is shift work. That is, doctors know their exact schedule for the coming months, and they never take their work home with them. Most hospitals have shifts that are 8 to 12 hours long. From talking with EM physicians and reading the SDN forum; it is recommended that EM docs work around 40 hours a week or so (avoiding burnout).

I love the camaraderie of the ER. I really feel like it is one of the places in every hospital where nurses, technicians, doctors, social works, and administrators all like each other. You have to work well with others (think team sports), and have a sense of humor about things.

My favorite thing about EM is that it is a combination of thinking and using your hands. I want to be a "Jack of all trades" (or if you are negative a "master of nothing" haha). EM is all about breadth of knowledge rather than depth in any single specialty. Quickly diagnosing someone is crucial, especially if the problem is life threatening. However, as an ER doc you also get to perform some cool procedures. Airway management is paramount, which can involve intubation and sedation. Lumbar punctures, sutures, ultrasound guided central line placements, NG tube insertion, arthrocentesis, defibrillation, and putting in chest tubes are just some of the examples. For something a bit more intense (and very rare) check out an emergency thoracotomy **warning graphic picture**

Also awesome...the job pays quite well. According to the AAMC, the annual salary ranges from $239,000–$316,296. Take a look at the graph from MDsalaries.com for even more information.

EM Doctor Salary

I think that an ability to think quickly and care for a wide variety of patients including trauma victims and sick children is required in this profession. Generally EM docs are calm under pressure, and have a variety of interests in and outside of medicine. I have found that I have loved bits and pieces of every specialty and body system we have learned about so far in medical school. Also on a sidenote, I have always wanted to be the guy in the crowd that can answer the call when someone yells "Is anyone a doctor?!" If this sounds like you, EM may be something you want to research further.

However, Emergency Medicine does not come without its disadvantages...

  • The ER is open 24/7, 365 days a year. That means you will be working on Christmas or your birthday some years. 
  • No Follow-Ups - This isn't the specialty for you if you care about continuity of care. There is no getting to know your patients on a deeply personal level, or seeing little Johnny grow up and get married.
  • Pressure - Is that patient you sent home with "heartburn" having a massive coronary? Can you handle multiple crashing patients and their families. Chances are you will see death, child abuse, and other terrible things on a regular basis.
  • Circadian Rhythm Disturbances - Some shifts may be like a traditional work day, however you will work overnight or during other awkward hours. Constantly changing your sleep schedule can leave you tired and grumpy.
  • Drug Seekers - Every ER has "regulars" that come in with vague symptoms to game the system and get high on narcotics.
  • Working in a Fish Bowl - The ER is the entrance gate for the hospital. That means that if you admit a patient, every doctor that comes into contact with the patient afterwards will be evaluating and judging your workup of said patient.