There is a definite finality to the decision of which specialty a physician pursues. The reasons are as vast as they are individual. Hopefully, the med student has done due diligence and has a solid grasp on what their future entails, at least for the future as far as anyone can confidently foresee. Here is my story.
1. Challenge. No day is quite like another, and life as an emergency medicine (EM) physician is full of unimaginable challenges. The knowledge required to competently practice EM is vast and must be combined with compassion and skill. Residents must master a variety of procedures and learn to do them quickly, as lives often hang in the balance.
In some respects, life as an EM attending mirrors that of a circus director. To an outsider, the emergency department (ED) appears chaotic, but the competent EM physician is orchestrating a complex domino-style arrangement. Each piece depends on another to do its job at the right time. When all this happens, patients are well cared for, and the ED hums along at a steady rhythm. An ED physician working in a busy ER quickly becomes a master conductor.
2. Teamwork. Life in an ED requires collaboration and the coordinated efforts of nurses, technicians, and support staff to deliver excellent patient care. Seasoned nurses have the insight to prevent mistakes and accepting comments and criticism only serve to improve a young physician’s skills.
Working in a larger hospital affords a set of extra hands. Everyone is entitled a bad day, and having another colleague to help with a difficult airway or complex patient builds camaraderie and eases the stress of working in a life or death environment.
3. Frontline Access. Rushing in to save the day was part of the lure of EM. Patients present with a vast array of problems, and the EM physician is expected to make quick decisions and act on incomplete information. The thrill of saving a patient from death is an incredible feeling and difficult to put into words. I recall several patient saves like they were yesterday, despite the lapse of nearly twenty years.
Patients bring EM physicians into the inner circle and allow direct access to everything. We ask difficult questions, probe into uncomfortable or taboo topics, and tease out critical pieces of data that allow the right diagnosis and treatment. EM physicians are the frontline of medicine and play a vital access point in the health care system.
4. Style. The prospect of putting on a tie and going to the same eight-to-four clinic job made me want to vomit as a med student. Not to downplay the importance of properly managed hypertension, but spending all day seeing six-month rechecks to control cholesterol and blood pressure in a clinic had no appeal. I wanted variety, flexibility and portability. A career in emergency medicine ticked all those boxes.
Lifestyle must be part of the decision-making process for every physician. Few specialties exist that include no call, no pager, scheduled shifts and the flexibility to work less than full time.
Mobility was also a big attraction, and finding a well-paying EM job in nearly any geographic location is relatively easy. Board-certified EM physicians are in short supply, and shift bonuses are common at present.
Looking past the wide-eyed enthusiasm of a young and often a single med student will require a conversation with a seasoned physician. The choices one makes at 23 are vastly different from those made by a 45-year-old with a family. I encourage spending time contemplating what a long career in medicine looks like and blend in the desire for a family, travel and pursuing non-medical interests. The freedom as an emergency medicine physician working 36 hours a week is vastly different from an orthopedic surgeon taking call a few nights a week and managing a busy practice.
Emergency medicine was the right choice for me. Have I ever thought about another specialty since? Yes, but the harsh reality of another residency keeps me grounded. By remaining creative, I have capitalized on the diversity of my knowledge, training and curiosity to create a path that didn’t exist when I was training nearly twenty years ago. Medicine continues to evolve at a steady clip, and tomorrow’s practice holds the promise of an incredible adventure. Emergency medicine physicians possess the knowledge, skill and management talents that easily translate into a variety of opportunity within and outside the walls of a hospital.