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