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Emergency Medicine

Overview

The popularity of NBC’s long-running television show “ER” is testament to America’s fascination with emergency medicine. Doctors who specialize in emergency medicine thrive on the relentless pace, the wide variety of patients and cases, and the challenge of making an accurate determination quickly.

A hospital’s emergency department (ED) can be a chaotic place. Some patients come to the ED with serious and even life-threatening symptoms, adding urgency to the doctor’s decision making process.

The doctors and nurses on staff must quickly prioritize incoming cases to ensure that patients with the most serious conditions are seen as soon as possible – a process known as triage, or “worst first.”

Physicians in the ED take a medical history, examine the patient, decide which tests to order, make a differential diagnosis and determine whether to admit the patient to the hospital or treat him and send him home.

Long shifts with heavy case loads of often critically ill patients can make working in the ED one of the most stressful jobs in health care. But for doctors who enjoy solving “medical mysteries” at breakneck pace, emergency medicine can be an exciting and rewarding career.

Note: Lynne Holden, MD, Associate Professor, Clinical Emergency Medicine, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, reviewed and approved this career profile. 

Working Conditions

In most hospitals, the emergency department operates 24 hours a day, 365 days a year. ED physicians typically work in 8, 10 or 12-hour shifts, during which they may see dozens of patients who have a wide range of symptoms or injuries.

The work requires physical endurance, mental acuity and the ability to control emotions.

Patients may come to the emergency department on their own or in an ambulance. The triage process determines the order in which patients are moved to treatment areas so they can be seen by the ED physician.

The first rule in the ED is “rule out the worst case scenario.” That means the ED physician must determine whether the patient’s symptoms could be caused by a serious medical condition.

For patients in distress, the ED doctor may perform emergency resuscitation, start intravenous lines, or take other steps to stabilize the patient before transfer to another hospital department. Less serious injuries, such as lacerations or broken bones, can be treated in the ED.

Other patients may be admitted to the hospital for further work-up. Some patients will be discharged to follow-up with their physician for a work-up.

Finally, the ED doctor must fully document the case. In a busy ED, patient charting can add significantly to the physicians’ workload. In fact, many emergency department physicians have to be reminded to eat and take bathroom breaks.

Academic Requirements

Becoming an emergency medicine physician takes years of preparation.  First, you must complete a four-year college degree, taking appropriate courses and earning high enough grades to be accepted into medical school.

You’ll be in medical school for four years training to become a medical doctor. During medical school, you will likely take a rotation in an emergency department.

The Liaison Committee on Medical Education (LCME), which oversees accreditation of U.S. medical schools, has recommended that all medical students spend some time in an ED, since every physician needs the ability to quickly assess a patient’s condition and design a treatment plan.

Following medical school, you’ll work as a resident for three or four years. Residencies in emergency medicine are highly competitive, so you’ll need excellent grades and recommendations from your medical school professors.

In order to qualify to practice emergency medicine, you must complete an emergency medicine residency approved by the Residency Review Committee.  Once residency is complete, board certification requires passage of both the written and oral examinations with recertification by written exam every 10 years.

Board certification also requires advanced training in life support and a passing score on the certification exam.