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Careers in Emergency Medicine

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I will not sell you a bill of goods. The right field for you is only ... Financial idiocy for hospital $65000/senior in PGY4 year. Resident lost wages ... – PowerPoint PPT presentation

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Title: Careers in Emergency Medicine


1
Careers in Emergency Medicine
  • Eric D. Katz, MD
  • Assistant Director
  • EM Residency Program
  • Washington University in St. Louis

2
54 male with chest pain and SOB
  • Who do you call/see?
  • Cardiologist
  • Emergency Physician
  • Internist
  • Family Practitioner

3
9 year old who fell down
  • Who do you call/see?
  • Pediatrician
  • Family Practitioner
  • Emergency Physician
  • Neurologist

4
19 female feeling depressed
  • Who do you call/see?
  • Emergency Physician
  • Psychiatrist
  • Internist
  • Pediatrician

5
I will not sell you a bill of goods
  • The right field for you is only determined by you!

6
3 Major Topics
  1. Is EM right for you?
  2. How do I choose the right residency?
  3. How do I get the residency to choose me?

7
What is EM all about?
  • Stabilization
  • Initial Diagnosis
  • Initial Disposition
  • Team work
  • Patient care when its needed
  • VARIETY!!!

8
Variety the good part You never know what is
coming through the door next.
Pathology vs. Bread and butter Surgical vs.
medical Pediatric vs. geriatric
9
Variety the bad part
  • You never know what is coming through the door
    next.
  • Chest pain
  • Psychiatry
  • OB/Gyn days

10
Advantages of careers in Emergency Medicine
  • Hours
  • Academic 28-36 hours per week
  • Private 32-40 hours per week
  • No beepers or office headaches!
  • Minimal catering to referral sources
  • Young field with easy route to leadership.
  • Room for a variety of interests in research,
    administration, education and private enterprise.

11
Disadvantages of careers in Emergency Medicine
  • Night and holiday shifts
  • Patient loyalty
  • Patient satisfaction ? appropriate care
  • HOSPITAL overcrowding safety net
  • Physician contract groups business
  • Life in the Fishbowl

12
EM Subspecialty Training
  • Pediatric EM EM or Peds
  • Sports Medicine EM, IM, FP, Peds, Orthopedics
  • Toxicology EM, Peds, FP, IM
  • Emergency Medical Services EMS
  • Disaster Medicine
  • Cardiovascular
  • International Health
  • Research
  • Administration

13
Emergency Medicine Research
  • Where are most acute care trials getting their
    patients?
  • EM research knows few boundaries
  • Stroke and neuro-protection
  • Resuscitation
  • Acute cardiac syndromes
  • Head injury and trauma
  • Pain management
  • Infectious disease

14
Follow the Money
  • Academic
  • Start at 150K plus strong benefits
  • Mean salary 180K
  • Very high job security
  • Community
  • Start at 180-240K plus variable benefits
  • Mean salary 240K
  • Variable security

15
Who goes into EM?
  • I loved every rotation but felt too limited by
    every field until my EM rotation.
  • Ive been an EMT for 12 years and knew from
    birth that I wanted to be an EP.
  • I really like to ski and want the lifestyle.
  • I dont want to be tied to a practice.
  • I have lots of other interests

16
Personality Types for EM
  • Working with the underserved
  • Enjoys fast pace first on the scene
  • Tends to be drawn to the outdoors
  • Interested in time for family
  • Team oriented work style
  • International health/travel
  • Work hard play hard club

17
The Big Myth
  • Burnout in EM is as high as 15 per year
  • The truth
  • EM BOARDED MDs have the same burnout rate as
    every other specialty. 5 per year (EM, IM,
    Peds, Surgery)

18
Myth 2
  • Why would you want to be half of a doctor when
    you can be a whole one?
  • The truth
  • Highly competitive specialty, experts in
    critical care, resuscitation, trauma and field
    medicine.

19
Myth 3
  • You can do another residency and moonlight in an
    ED if you want to
  • Boarded EPs are cost-efficient, faster, and
    better than any other physician in an ED.
    (proven)
  • Times have changed
  • Training and certification count
  • Fewer opportunities for those not trained

20
Emergency Medicine Residency
21
The Training
  • Community vs. Academic
  • PGY 1-3 vs. 1-4 vs. 2-4
  • Program size (18-50)
  • Patient mix and acuity
  • Location
  • The best program in the country?

22
How difficulty is it to get into EM?
  • 1747 applicants for 1242 spots last year
  • 7 programs didnt fill in last years match (13
    spots)
  • International medical graduates
  • Osteopaths
  • Prior Training
  • Previously failed to match
  • Bottom line it isnt as bad as it seems!

23
The basics
  • Residency is doable and available
  • Find the right program for your strengths and
    needs
  • Pick your program carefully
  • you will spend half of your life in the hospital
    for the next 3-4 years.
  • Emphasis on lifestyle with lots of room for
    academic and leadership pursuits.

24
Residents
  • Support
  • Social life
  • Teaching and learning
  • Camaraderie
  • Talk with residents!!!

25
EM Faculty
  • Experience levels
  • Supportive?
  • Teaching style?
  • Bedside teaching quality?
  • Supervision vs. autonomy?
  • Residency leadership -- supportive?

26
Institution
  • Presence of other residency programs
  • Primary and affiliated sites?
  • Financial stability
  • Radiology and ancillary services
  • Informatics Computer resources
  • Hospital Admin Medical records

27
Support of Emergency Medicine
  • EM resources
  • Division vs. Department?
  • Role in trauma / airways?
  • Procedural sedation agents?
  • Admitting privileges?
  • Holding orders?

28
Trauma
  • Volume?
  • Type?
  • Organization?
  • Competence?

29
Pediatric EM
  • Volume?
  • Dedicated pediatric ED?
  • Peds EM faculty?
  • Off-service rotations?
  • Pediatric resuscitations?
  • Airway management?

30
Other Staff
  • Nursing/Ancillary
  • Experienced?
  • Adequate numbers?
  • Rapport with residents?
  • Consultants
  • Team players?
  • Teaching?
  • Medical students

31
Program Format
  • 3 vs. 4 years
  • Research opportunities
  • Patient population
  • Volume?
  • Acuity?
  • Off-service rotations -- purpose, quality, role?
  • County vs. University
  • Single vs. multiple training sites

32
Absolute Truths
  • EM is the only specialty with multiple training
    pathways
  • Successful ABEM certification is the only hurdle
    that really matters
  • Everyone has an opinion
  • There is no best answer

33
Historical Context
  • Early residency training was set at 2 years
  • Programs expanded to 3 years in the 1980s
  • ABEM requires a minimum of 36 months of training
    in EM in order to sit for the certification
    (board) examination
  • The board initially intended 3 years following an
    intensive in-patient year (PGY2-4)
  • Market forces came into place
  • Concerns about competition for transitional slots
    caused many to embrace a PGY1-3 format

34
The Bottom Line - 2004
  • PGY 1-3 100 75
  • PGY 1-4 16 12.5
  • PGY 2-4 16 12.5
  • Why would an applicant choose to invest in an
    extra year of training?
  • Why would an institution design a longer than
    required program of training?

35
3-Year Format
  • Finishing sooner makes sense
  • Able to work independently
  • Fellowship and sub specialization await
  • Financially sound
  • More income - 100000 more than as resident
  • Start repaying debt sooner
  • youve waited a long time already

36
3-Year Format
  • Job competition from 4 year graduates
  • Which would you hire?
  • Confidence gap (real and perceived)
  • Steep learning curve on the job
  • Caught up after 1 year in practice
  • Harder to get academic positions
  • 3 year grad cant be faculty at 4 year program
  • what do you bring to the institution?

37
3-Year Format
  • Limited elective time
  • Minimal experience
  • Gotta learn everything in 3 years
  • Constrained by curricular requirements
  • Little opportunity to explore other areas within
    emergency medicine
  • Im not sure what I want to do!

38
4-Year Format
  • More seasoned and confident
  • Time to address areas of relative weakness
  • Tailor education to future career goals
  • Sheltered learning environment
  • Opportunity to do procedures, teach and supervise
  • Develop your own style
  • Manage ED flow
  • Impact of CMS teaching rules

39
4-Year Format
  • Scholarly productivity increased
  • Electives
  • Everyone is different
  • Develop areas of minor expertise
  • What proportion really accomplish this?
  • Most sub specialty areas within EM dont have a
    certification pathway
  • Do you need to do a formal fellowship?
  • Unlike medical specialties limited financial
    benefit

40
4-Year Format
  • Financial idiocy for hospital
  • 65000/senior in PGY4 year
  • Resident lost wages
  • Loan repayments loom
  • Moonlighting isnt the same
  • If really academically geared
  • 3 years fellowship is more efficient

41
Certification Pass Rates
  • No difference in In-service scores
  • No difference in certification exam pass rates
  • The core content of EM can be mastered in 3
    years
  • The results implies competency but the test
    doesnt evaluate real-time clinical interaction

42
3 vs. 4 Year Training Tracks
  • All approved programs will provide trainees with
    a solid foundation in the practice of Emergency
    Medicine
  • What is the programs specific mission statement?
  • How do they address it in terms of training?

43
The application process
44
How to get the spot
  1. Getting involved
  2. Rotations
  3. Applications
  4. Making your list
  5. Getting advice

45
Getting involved
  • Summer research projects
  • 3rd year clinical rotation
  • Interest group
  • PERSONAL CONTACT

46
Rotations
  • Usually do two different ones, at least one of
    which MUST be at a residency site.
  • Community vs. academic base
  • County vs. private
  • Rural vs. urban
  • Away rotations
  • Choose them early
  • Check schedule

47
Applications
  • The early bird gets the worm
  • Personal statements
  • Safe vs. clever
  • What are your weak spots? What are your
    strengths?
  • Building the resume with research, volunteer
    work, hobbies, etc.

48
Making your list
  • Getting information
  • SAEM Residency Catalog
  • EMRA Residency page
  • Grads from here
  • Location
  • Format
  • Program philosophy

49
Getting advice
  • Find a mentor with some experience in EM
  • EMIG advisors can help
  • SAEM virtual advisor
  • Outside rotation attending
  • Previous graduates
  • The interview trail but be careful!

50
Interviews
  • Its a search for psychopathology
  • Stress interviews are a thing of the past
  • Resident opinion counts
  • Secretary opinion counts

51
Playing the Game
  • Just dont.
  • Illegal questions deserve illegal answers
  • 94 of US grads going into EM match in their top
    3.

52
Its all about family and friends
53
Summary
  • This is a good gig if it is right for you.
  • Residency is achievable and reasonable.
  • When in doubt, go for your best fit.

54
Thank you for your time!
Eric D. Katz, MD Assistant Professor Assistant
Director, EM Residency Program Washington
University in St. Louis Katze_at_msnotes.wustl.edu 31
4-362-7983
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