​BROWARD EMERGENCY MEDICINE

There comes a time in the life of every medical student when he or she must choose a specialty.  This will no doubt be one of the most important decisions you will ever make. Your specialty choice will not only define your career as a physician but in many ways will provide the framework for the rest of your life. Your choice of specialty will not only determine how you will spend your professional life but will have a huge impact how much time you will have for other interests. This decision should be made after great soul searching and an understanding of the specialty you are considering. 

The Specialty of EM. Emergency Medicine is a unique specialty that involves the initial evaluation, resuscitation, and stabilization of all patients presenting to the emergency department. It is faced-paced and unpredictable. A good emergency physician (EP) will possess a wide breadth of medical knowledge combined with the ability to make quick decisions often with limited information. Anyone considering the specialty must be comfortable with the feeling of uncertainty. You can’t predict what type of patient will walk through the door and you often will admit or discharge them without knowing their diagnosis. The EP will start the initial workup on a complaint but despite our best efforts, many will leave the ED with a diagnosis of “chest pain” or “undifferentiated abdominal pain”. This feeling of uncertainty is befitting for some personalities but not others. 

The Patients.  Emergency Medicine is different from primary care in that you will see patients on their worst day—when they are facing a crisis such a motor vehicle accident, a heart attack, or a fracture. There is great variety with patients of all ages and walks of life. The ED is the healthcare system’s “safety net,” often providing care for patients that no one else is willing to care for.  Many of our patients are indigent, intoxicated, or brought to the ED involuntarily. These patients present a challenge for even the most seasoned EP. Providing compassionate and sound medical care for even the most difficult patients is an important skill for any emergency physician.

Working in the ED.  Emergency physicians work on healthcare’s front line seeing diseases of every acuity and organ system. You must be a “jack of all trades” in order to be able to manage any problem that presents to you. EPs are highly trained to handle any problem that is dealt to them. You must also be humble enough to know your limitations and be comfortable with the fact that other physicians will typically know more than you in their particular specialty. Some EPs struggle with the criticism that sometimes comes from other specialists and physicians who see the patient “downstream” from the ED. This criticism can sometimes contribute to burnout within the specialty. This will be discussed later. 

Lifestyle.  Many medical students are attracted to Emergency Medicine because of the lifestyle. Shift work has some great benefits such as no “on call” responsibilities. Consider the average primary care physician or surgeon. He or she would have a Monday through Friday office schedule, plus a share of the “on-call” schedule. This leaves only a handful of days during the month that are truly free of any clinical duties. On the other hand, the average full-time EP will work between 10 – 18 shifts per month typically based on preference of the physician. This schedule allows for outside interests such as family, travel, and hobbies. Shift work also allows much more flexibility than an “office-based” schedule. Need more time with your family? Decrease your shifts. Want to make more income? Increase your shifts. Increasing, decreasing, and swapping shifts with your colleagues is much easier as an EP doing shifts than the office-based schedule of other physicians. 

There is also the downside of shift work.  Yes, you will work some nights and weekends.  The switching from days to nights can disrupt circadian rhythms.  You will have to work on some holidays throughout the year.  However, most EPs will take the tradeoff in order to have more days off overall throughout the year.

Burnout.  By now, I am sure you have heard about the concern of burnout in the specialty of EM. Burnout occurs when the initial energy and enthusiasm of medical practice is replaced over time by exhaustion, cynicism, bitterness, discomfort, and a sense of isolation. Burnout can occur in any specialty but recent studies have shown that EPs are particularly at risk*. This is multifactorial but many attribute this to a highly stressful environment, the patient population and the aforementioned criticism from other downstream physicians. Regardless of the cause, burnout is a real problem that many physicians will face. The best way to prevent burnout is to choose the right specialty for your personality type. If you choose the wrong specialty, you will dread going to work and burnout may be inevitable. If after careful thought you have decided that EM is the best fit for you, there are steps that you can take to avoid burnout**. For starters, developing interests within the specialty have been shown to decrease the odds of burnout. This may be research, teaching, or writing in EM publications. Being involved in leadership positions and hospital committees can also help. You can also be involved with state and national organizations such as ACEP, FCEP, SAEM who can connect you with physicians with similar interests. Lastly, take advantage of vacation time to relax and recharge. Being overworked can cause burnout in any specialty.

Choosing the Right Specialty.  The most important measure in deciding if emergency medicine is truly for you is by doing an elective in the ED. Nothing can substitute for clinical experience and time in the department. You should talk personally to board-certified, residency-trained emergency physicians in your community in addition to physicians in academic teaching centers. This will help you better understand the broad spectrum of career opportunities in emergency medicine. Request a mentor through the FCEP database to help you answer questions about the specialty and life as an EP. Having a personal advisor guide you in your career path and academic training will help you make a wise decision.

You should sincerely love the specialty that you choose. You should look forward to going to work every day and feel good about the job that you do. Take the time to carefully think through your decision and focus on a balance between your professional and personal goals. Your career should bring out the BEST within you. You should feel direction, purpose, challenge, and motivation about your work. For me, emergency medicine was that perfect fit.  Only YOU can answer if it is the right fit for you as well. 

Jason Mansour, MD

* Shanafelt TD et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012 Oct 8;172(18):1377-85.

** Cydulka RK et al. Career satisfaction in emergency medicine: the ABEM Longitudinal Study of Emergency Physicians. Ann Emerg Med. 2008 Jun;51(6):714-722.e1.

Is Emergency Medicine the Right Specialty for Me?

By Jason Mansour, MD