Scope of Practice

Emergency Medicine is the practice of medicine in an acute and sub-acute setting. The emergency physician’s role is to assess; treat, admit, or discharge any patient that seeks medical attention at any time of day or night. It is the emergency physician’s job to take a full history, perform a physical exam, and obtain the tests that will elucidate the cause of the patient’s complaint. Upon doing so, the physician must either treat the patient or refer him/her to the appropriate follow up care. A trained emergency physician is able to handle not only traumas, but also almost every other imaginable acute and non-acute problem. Because most hospital admissions come through the Emergency Department (ED), it is imperative that the Emergency Medicine (EM) physician have a good grasp of most fields of medicine.

The ED is an extremely exciting and vibrant setting. One patient may have a laceration or broken bone while in the next bed over, a patient may be suffering an acute MI. Because of this variety, the Emergency Physician receives training in a wide diversity of procedures (central lines, lumbar punctures, chest tubes, ultrasound, etc.). This training and ability is what keeps the scope of practice lively and ever-changing.

Upon completion of a residency program, there is the opportunity to receive additional training in many subspecialty areas of emergency medicine. This allows the physician to tailor his/her knowledge base and lifestyle to their particular interests. Some areas of fellowship or further training include toxicology, medical informatics, pediatric EM, ultrasound, EMS, medical education, sports medicine and Masters of Public Health, Business Administration, or Health Public Education. If upon completion of training the physician decides that a fellowship is not what he/she wants, there are a variety of job opportunities available. Our residency graduates have received jobs in both academic as well as community

practice.  An EM trained physician need not simply work in an ED though.  There are urgent care centers where the physician works a regular nine to five shift and goes home.  There is also the ability to work as ship’s doctor on cruise ships or as a physician at vacation resorts all over the world.  This flexibility is one of the great appeals of EM.

Emergency Medicine Residency

Because Emergency Medicine is such a new specialty, there is still change taking place. Due to this, there exist several types of residency programs. Along with the traditional 1-3 and 1-4 post-graduate training programs, there also exist PGY 2-4 programs. With the four year 2-4 programs an internship year is required prior to the applicant starting his/her EM training. Residency programs vary considerably by the amount of hours and rotations spent in the Emergency Department (ED) and other off-service areas. To become acquainted with the varying EM programs, their requirements, formats, and training, I urge you to visit the Society for Academic Emergency Medicine’s web site (www.saem.org).

The lifestyle during an EM residency varies greatly from program to program. When a resident is working shifts in the ED, once that shift is over, he/she is free to go home. There is no call, pre-rounding, rounding, or writing notes on patients the next morning. If the resident is not scheduled to work the following day, s/he is not obliged to come in. During the off-service (rotations other than the ED), the resident follows the schedule of the service s/he is on. This means that s/he must take call as well as round on patients, just as the other residents on the service. Off service rotations usually account for far less than 50% of the time the resident spends in training, so the amount of time taking call and all of the other ward service work is significantly less than in most other residencies.

Pros & Cons of Emergency Medicine

Many specialists view the emergency physician as someone who simply evaluates a patient and then triages them to the appropriate physician. This is in fact far from the truth. A good Emergency Physician will evaluate and treat over 90% of his/her patients without a referral or a consult. This necessitates that the physician have a solid, broad base of most other areas of medicine, including surgery, internal medicine, pediatrics, psychiatry, and ob/gyn. This broad knowledge base, coupled with the plethora of procedures, is what draws people to the specialty and is what keeps the job from becoming monotonous.

Emergency Medicine has also drawn people because of its lifestyle. Because a physician does not have his/her own patients, the job allows for a much greater level of flexibility. For instance, a physician may work on a cruise ship during the summer and then in Vail, Colorado during the winter. The lack of need in sustaining a patient base allows one the personal freedom to work as little or as much as desirable and to take vacations at any time. Part time work is also available, something which is difficult in other specialties, especially when first starting out. This flexibility in working hours allows a person to take time out to raise a family or to explore other interests. The major problem that most people seem to focus on with Emergency Medicine is “burn out.” This used to be a problem when the specialty first started because people would work multiple shifts in order to supplement their incomes. After several years of sleepless nights and days, the schedule took its toll and these people stopped practicing. If a physician paces him/herself and does not work more than 55-60 hours per week, it is possible to keep working well into your 50’s

Emergency Medicine has also drawn people because of its lifestyle. Because a physician does not have his/her own patients, the job allows for a much greater level of flexibility. For instance, a physician may work on a cruise ship during the summer and then in Vail, Colorado during the winter. The lack of need in sustaining a patient base allows one the personal freedom to work as little or as much as desirable and to take vacations at any time. Part time work is also available, something which is difficult in other specialties, especially when first starting out. This flexibility in working hours allows a person to take time out to raise a family or to explore other interests.

All of the above mentioned aspects of Emergency Medicine have made it a very highly desirable and sought after residency. It is a competitive field with some of the brightest and smartest minds. If you are interested in EM, please feel free to contact the Clerkship Director with any questions, comments, or concerns. The best recommendation that I can make is to start early, get involved with our Emergency Medicine Interest Group and really see for yourself if EM is for you.