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Frequently Asked Questions

1. What is Emergency Medicine?

Emergency Medicine focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. Source: AAMC, Extracted from the American Board of Medical Specialties."Guide to Physician Specialties."

2. Aren't Emergency Physicians just glorified triage nurses?

No. Though there was a time when the job of the physician was simply to figure out which service to call and try to keep the patient alive in the interim. Prior to the 1960's and 70's, hospital "emergency rooms" (see q#4) were generally staffed by physicians on staff at the hospital on a rotating basis, among them general surgeons, internists, psychiatrists, and dermatologists. Physicians in training (interns and residents), foreign medical graduates and sometimes nurses also staffed the ED alone at times. This method was fraught with problems as the internist didn't know enough about surgery, the surgeon didn't know enough about medicine, and no one felt comfortable sending most people home. Once residency programs developed that taught several issues, including trauma, surgery, internal medicine, airway management, and subspecialty experience it was found that the specially trained Emergency Physician can manage emergency patients better than a physician not boarded in EM when malpractice cases are used as a readout.

3. How did Emergency Medicine come to be a specialty?

During the French Revolution, after seeing the speed with which the carriages of the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey applied the idea of Flying Ambulances for rapid transport of wounded soldiers to a central place where medical care was more accessible and effective. Larrey manned Ambulances with trained crews of drivers, corpsmen and litter-bearers and had them bring the wounded to centralized field hospitals, effectively creating a forerunner of the modern MASH units. Dominique Jean Larrey is sometimes called the father of Emergency Medicine for his strategies during the French wars.
EM was born as a specialty in order to address the problem of the "ER" (see q#4), propagated by published reports and media coverage of the poor state of affairs for emergency medical care. This culminated with the establishment of the first emergency medicine training program at Cincinnati General Hospital, with Bruce Janiak, M.D. being the first emergency medicine resident in 1970 . The first of such groups formed at Alexandria Hospital, VA and their plan of establishing emergency care through the efforts of full-time emergency physicians was to become known as the "Alexandria Plan". During the 1970's, several other residency programs developed throughout the country. It was not until the establishment of ACEP, the recognition of emergency medicine training programs by the AMA and the AOA, and in 1979, a historical vote by the American Board of Medical Specialties that EM became a recognized medical specialty. - Partially adapted from Wikipedia "Emergency Medicine"

4. Why do you call it Emergency Medicine and not ER?

Emergency Medicine does not occur in a "room," but is much broader in scope. ER is an old term used before there was an Emergency Department and before there was Emergency Medicine as a specialty. At that point, there was literally a triage room and ER was an appropriate term. Now, it is no more accurate than calling a surgeon an "OR doc" and is considered insulting by many who were involved with the founding of the specialty. - Adapted from statements made by Dr. Gus Garmel

5. Is Emergency Medicine for me?

Did you enjoy most of your clinical rotations? Do you like variety? Working with your hands? Multi-tasking? Team-work? Working with all types of patients, including those that are down on their luck? Do you stay calm under pressure? Can you handle not being the "expert" (breadth rather than depth?) If so, EM may be for you! On the other hand, if you want a long-term relationship with your patients, if you don't want to work holidays and weekends, like having downtime at work, can't handle criticism from other medical services, or prefer not to get your hands dirty - there is nothing wrong with any of these things, but you should think carefully before applying to EM. Here are some resources to help sort it out:

AAMC Careers in Medicine
You will need a code form Barb Wagner to access it, but it can be a helpful resource for choosing a specialty
SAEM's EM as a career choice
A nice essay detailing aspects of working EM down to practice locales and the job market.
Medical Specialty Aptitude Test
A 130 question test that spits out a list of specialties for you based on your selections Should I go into EM?
An irreverent student doctor list, take it for what it is

6. How competitive is Emergency Medicine?

Emergency Medicine has become a very popular career choice over the years, with over 1100 U.S. seniors applying in 2005. The match rate for U.S. seniors is in the low 90s, and successful applicants have an average Step 1 score of 219 (though the range is wide). 10% of applicants were AOA in 2005. For more info on EM's competitiveness, check out the document this data is from "Charting Outcomes in the Match" by AAMC. For more info on residency applications, etc, just click the residency tab!

7. Isn't the shiftwork on Emergency Medicine pretty hard?

It's true that the Emergency Department, like inpatient medicine must be open 24/7. Other specialties consider continuity of care and thus use call schedules to cover the night time. In this way interns normally get some sleep - little other than occasional emergencies and the need for sleep aids occur overnight on the floors because the patients have already been stabilized. On the other hand, the ED may be just as active at night as it is by day. Thus, fresh physicians are more important than continuity, and shiftwork prevails. While you won't be working 36 hours straight every four days like you may on call, the disruptions to the circadian rhythym in alternating between night and day shifts are very real. Of course, the reality is that many professions practice night shifts, and we all do just fine. For more information, check out this great eMedicine article.

For other questions, email us with your suggestions or consult the Mentor thread on the Student Doctor Network fr more personal inquiries.