So you want to be an emergency medicine doctor.
You like the idea of high pressure, adrenaline,
and saving people’s lives. Let’s debunk
the public perception myths of what it means
to be an emergency medicine doctor, and give
it to you straight. This is the reality of
emergency medicine.
Dr. Jubbal, MedSchoolInsiders.com.
Welcome to our next installment in So You
Want to Be. In this series, we highlight a
specific specialty within medicine, such as
emergency, and help you decide if it’s a
good fit for you. You can find the other specialties
on our So You Want to Be playlist. A lot of
you asked for emergency medicine in our poll,
so that’s what we’re covering here. If
you want to vote in upcoming polls to decide
what future specialties we cover, make sure
you’re subscribed.
If you’d like to see what being an EM doctor
looks like, check out my second channel, Kevin
Jubbal, M.D., where I do a second series in
parallel called a Day in the Life. Once the
world is back to a more normal baseline, we’ll
be doing a Day in the Life of an Emergency
Medicine doctor.
Emergency medicine is the specialty concerned
with treating patients who are acutely ill
with urgent healthcare needs. This can be
treating acute conditions like a myocardial
infarction, or heart attack, or treating exacerbations
of chronic health conditions, stabilizing
patients involved in trauma, and more.
Because EM doctors treat acute conditions
from every field of medicine, they have to
know a little bit about everything, but don’t
dive deep in any one specific domain. Think
of them as the jack of all trades, master
of none. If you’re having a heart attack
and don’t have a cardiologist nearby, seeing
an EM doc is the next best thing. As my emergency
medicine colleague says, “if you ever have
a medical problem, we are the second best
doctor.”
Generally speaking, the job of the EM doctor
is to stabilize the patient and then refer
them to the specialist in the appropriate
field. For example, if a patient comes in
with multiple fractures after a motorcycle
crash, they’ll stabilize the patient’s
airway, breathing, and hemodynamics, meaning
their blood pressure and circulation. After
that, they’ll call the orthopedic surgeons
to assess the extremity fractures and the
plastic surgeons to address the facial trauma.
By the way, that’s an actual case from when
I was in plastic surgery residency.
The practice of emergency medicine is largely
a function of location — what type of hospital
do you work at?
At an academic center, you’ll be at the
cutting edge of research, equipped with the
latest and greatest in medical technology,
therapies, and resources. In terms of salary,
you won’t get paid as well as a community
or private practice doctor, but you’ll have
better benefits and job security. You’ll
have protected time to pursue research, and
you’ll enjoy paying it forward by mentoring
and teaching medical students and residents.
If you’re at a Level I Trauma center, you
may expect to see more complex cases compared
to other settings.
As a community emergency medicine doctor,
expect to “do everything.” At a larger
community hospital, there will be more specialists
for support, but at smaller community hospitals
in more rural settings, there’s less support
and a larger scope of practice. You’ll be
treating more on your own, but you’ll also
be transferring more complicated patients
to other facilities that are better equipped.
Lastly, urgent care is unique in that you’re
working at a stand-alone facility, generally
without a hospital or other specialties for
backup. You’ll be handling lower acuity
cases, with the option to transfer patients
to the emergency department, or ED, for sicker
patients. This is a less stressful environment
and is considered a good option for doctors
wanting to ease a bit toward the end of their
careers.
For many nonsurgical specialties, you first
do three years of internal medicine residency,
and then subspecialize into gastroenterology
or cardiology or infectious disease or another
specialty through fellowship. Emergency medicine
is different as it has its own residency training.
Emergency medicine residencies are either
3 or 4 years in duration. Some experts in
the field say that 4 year training programs
are optimal, as it provides better preparation,
an opportunity to further develop personal
maturity, improve in patient interactions,
and have greater self-confidence. Additionally,
it provides more time to explore and pursue
areas of interest, such as those related to
research.
On the other hand, 3 year programs have distinct
advantages, such as spending 1 less year in
training and earning an attending salary 1
year sooner. Plus, most graduates say they
are as satisfied with their training and don’t
feel they are lacking in preparation.
On average, more academic institutions with
research incorporated into the training will
have four year programs, whereas more community-focused
institutions without a research focus will
have three year programs.
Given the highly diverse and varied nature
of emergency medicine, it makes sense for
the residency curriculum to also be highly
diverse and varied. Most of your time will
be spent on emergency medicine rotations,
but there’s also rotations on trauma, orthopedics,
ultrasound, critical care, anesthesia, pediatric
ICU, obstetrics, and more.
Emergency medicine paved the way in residency
admissions with the Standardized Letter of
Evaluation, or SLOE. Applying to residency
is similar to applying to medical school in
that you fill out your primary application
with your personal statement, but also submit
letters of recommendation. The SLOE is a way
to standardize the letter of recommendation.
Rather than a gushing letter saying how great
you are, the letter writer must answer a standardized
set of questions, such as the nature of how
you know the student, their commitment to
emergency medicine, how they compare to their
peers, and more. This makes it much easier
to quantify, standardize, and compare letters
of recommendation. This will likely become
more commonplace amongst other specialties
as Step 1 transitions to Pass/Fail.
The residency interview process is more laid
back than most other specialties, which is
reflective of the specialty being less formal
than most. Rather than grilling you on standardized
questions, EM interviews are more about the
“Beer Test”, meaning having a casual conversation
and deciding whether this is someone you’d
enjoy having a couple beers with after a shift.
The stereotypical EM applicant is the student
who loved everything in medical school, who
couldn’t sit still, and always needed to
be active and doing something. They’re the
ones that want to know a little bit about
a lot of things, rather than a lot about a
few things. Some would even say ADD, easily
distracted, and always on the go. These are
often the athletic, outdoorsy, and adventurous
types who enjoy camping, running, and rock
climbing.
As with other fields in medicine, you can
subspecialize with fellowship after completing
your residency.
One of the most popular EM fellowships, sports
medicine is concerned with non-operative treatment
of musculoskeletal injuries, pre-participation
evaluations, and management of acute and chronic
medical conditions of athletes. If you want
to do operative treatment, you’d want to
check out orthopedic surgery with a sports
medicine fellowship, which we covered in a
previous video.
Wilderness medicine is focused on meeting
the unique challenges of emergencies in austere
environments. This includes tropical and travel
medicine, hypothermia, altitude related illnesses,
envenomation, and other animal related injuries.
Ultrasound is being pushed heavily in the
ED for its noninvasive diagnostic strengths.
Fellows specializing in ultrasound also get
to explore novel and future uses of the technology.
Toxicology focuses on the treatment of drug
overdoses and withdrawals, envenomation, chemical
exposures, and toxic ingestions.
If you want to work in the pediatric emergency
department, you’ll complete a peds fellowship
after completing your emergency medicine residency.
Hyperbaric medicine focuses on using hyperbaric
chambers and hyperbaric oxygen therapies for
certain conditions, and also includes the
medical aspects of deep sea diving.
EMS, often combined with disaster medicine,
focuses on pre-hospital care. This translates
to ground or air transportation and responding
to or managing larger disasters.
There’s a lot to love about emergency medicine.
In terms of lifestyle, some love it, others
hate it. On average, EM doctors work around
40 hours per week, which usually translates
to 3-4 shifts every 7 days, meaning you have
several days off. This is shift work, meaning
you clock in and clock out, and don’t take
work home with you, which isn’t something
you can say about most other specialties in
medicine. It’s a double edged sword though
— that also means you’ll be working irregular
hours depending on your shifts, whether during
the day or at night, so a regular circadian
rhythm is hard to come by. Also, it’s not
uncommon to miss important family events or
holidays, which might actually be a good thing.
Compensation amongst emergency medicine doctors
is highly variable based on the region and
type of hospital you’re practicing at. We
found the highest salary of $395/hour in New
Mexico, and the lowest of $130/hour in New
York. The average EM doctor makes roughly
$350,000 per year. EM is also unique in that
sometimes it’s more of an “eat what you
kill” compensation structure, meaning the
more patients you see and more hours you work,
the higher your compensation.
There’s a great deal of team dynamics at
play in emergency medicine, as you’re constantly
working with nurses, techs, and doctors of
other specialties. There’s a large degree
of social interaction at play, not only between
healthcare professionals, but you’ll be
having a large amount of face time with patients
and their families as well. You’ll constantly
be on your toes the entire shift, without
much downtime or breaks between patients.
Some love the fast pace, whereas others wish
they could get more than a couple minutes
to scarf down a snack.
EM can also be incredibly exciting, with a
large amount of uncertainty. You won’t know
what types of patients are coming in, or when
they’ll be coming in. You have to be ready
for anything.
Emergency medicine is not without its drawbacks.
Unfortunately, a large number of patients
abuse the emergency department which can prove
to be a large source of frustration. This
is not discussion about why the ED is abused,
social issues, political issues, or what changes
should be made to curtail this, but rather
what you’ll be experiencing as a physician
working there.
My EM colleague who helped me in the creation
of this video mentioned a patient coming in
for dry cracked lips during the current pandemic.
No, that’s not a joke. You’ll also have
illegal immigrants or uninsured patients using
the ED as their source of primary care rather
than for urgent medical conditions. Homeless
patients may feign medical conditions to secure
a roof over their heads and food to eat for
a night. Those addicted to narcotics visit
the emergency department exhibiting drug seeking
behavior to secure pain killers, which has
become an increasingly common issue given
the opioid epidemic.
These situations aren’t necessarily the
patients’ fault, but as an emergency medicine
physician, the emergency department serving
as a safety net becomes a source of frustration.
Dealing with highly agitated or intoxicated
patients also means that EM doctors are at
higher risk of physical harm from patients
compared to most other specialties.
For these and other reasons, EM doctors experience
some of the highest rates of burnout. Some
contributing factors include working on the
front line, consistent high intensity and
stress, unpredictability, increasing time
required for charting at the expense of patient
interaction, and irregular circadian rhythm.
There’s also a fear of litigation looming
over your head given the higher rates of malpractice
claims compared to the average physician.
You won’t be seeing exciting stuff nonstop
either. The bread and butter, meaning the
most common things you’ll be seeing day
to day, often include chest pain, abdominal
pain, and headaches. The standard workup can
become monotonous and the treatments are not
always definitive.
Lastly, you may get some heat from other specialists,
who are quick to forget that EM doctors must
go an inch deep but a mile wide, whereas most
other specialists go a mile deep and inch
wide. You won’t know the nuance of every
condition, because your job is simply to handle
urgent cases, stabilize, and handoff to the
specialists when appropriate. For this reason,
some specialists will get frustrated at you
for not managing cases to the same degree
of nuance that to them may seem obvious.
How can you decide if emergency medicine is
a good field for you?
If you thrive in fast paced, sometimes chaotic,
and unpredictable environments, it may be
a good fit. You shouldn’t mind working an
entire shift with nonstop action, even if
it isn’t always the most exciting action.
You may be forced to practice intermittent
fasting, more specifically time restricted
feeding, as you won’t have much down time
on your shifts. You’ll work hard when you’re
at work, but you’ll get to completely unplug
when you’re off. No pager, no following
up on patients or taking home call.
You should enjoy the reward of saving lives,
as emergency medicine is one of few specialties
that truly do. You won’t always be thanked
though, as patients are in the scariest and
most stressful moments of their lives.
You also shouldn’t shy away from procedures
— you’ll be doing more than most other
medical specialties, although obviously not
as much as surgeons. These procedures are
wide ranging, including incision and drainage
of abscesses, lumbar punctures, paracentesis,
thoracentesis, suturing lacerations, reducing
fractures, and even thoracotomies and chest
tubes.
Big shout out to Dr. Jacob Szmuilowicz, attending
emergency medicine physician, who was instrumental
in helping me create this video. A large thank
you to the multiple emergency medicine physicians
at MedSchoolInsiders.com who also provided
their input. If you’re interested in pursuing
emergency medicine, who better to learn from
than the EM doctors themselves. If you need
help acing your MCAT, USMLE, or other exams,
our tutors can maximize your test day performance.
If you’re applying to medical school or
emergency medicine residency, our EM docs
can share the ins and outs of what it takes
and how to navigate the process most effectively.
Learn more and see why we have the highest
satisfaction ratings in the industry at MedSchoolInsiders.com
Thank you all so much for watching! What specialty
do you want me to cover next? Leave a comment
down below, and make sure you’re subscribed
to vote in the upcoming polls. If you enjoyed
the video, hit that thumbs up button to keep
the YouTube gods happy. Much love to you all,
and I will see you guys in that next one.
