1 Introduction to Emergency Medicine Slides Courtesy of American College of Emergency Physicians

2 Everything you want to know about Emergency Medicine-and dare to ask John Cunha, DO Attending Physician Holy Cross Hospital Ft. Lauderdale, FL

3 Lecture Objectives Convey an understanding of the field of Emergency Medicine Discuss pros and cons of specialty Describe emergency medicine residency training Monetary considerations

4 History of Emergency Medicine Emergency Departments Staffed by physicians of various backgrounds Staffed by physicians of various backgrounds No specialty training No specialty training American College of Emergency Physicians Established 1968 Established 1968ACOEP Established in 1975 Established in 1975

5 Emergency Medicine Residency First “resident” First residencies University of Cincinnati University of Cincinnati Emergency Medicine Residents’ Association

6 Emergency Medicine Residency Emergency Medicine Residencies programs programs programs programs AOA programs, 138 AMA programs AOA programs, 138 AMA programs Multiple “combined programs” Multiple “combined programs”

7 Specialty Selection Top Ten Leading Causes of Death in the U.S. Heart Disease: 726,974 Cancer: 539,577 Stroke: 159,791 Chronic Obstructive Pulmonary Disease: 109,029 Accidents: 95,644 Pneumonia/Influenza: 86,449 Diabetes: 62,636 Suicide: 30,535 Nephritis, Nephrotic Syndrome, and Nephrosis 25,331 Chronic Liver Disease and Cirrhosis: 25,175

8 Exciting Patient Encounters Motor vehicle versus pedestrian accident Acute myocardial infarction 24 yo with GSW to chest 66 yo with CPR in progress

9 What’s Your Diagnosis ?

10 What’s Your Diagnosis ?

11 Not So Exciting Patient Encounters 5 yo with Asthma 75 yo with Emphysema 45 yo alcoholic vomiting blood 3 week old with fever of week pregnant female with vaginal bleeding

12 Everyday Non-emergent Patient Encounters 25 yo with a rash Homeless patient with no other physician Back pain for 3 months Migraine headache Ran out of medicines

13 Employment Opportunities Urban, rural, or suburban hospitals Teaching or community hospitals Trauma or not-trauma Trauma or not-trauma Traveling (Locum tenens) physicians International opportunities Third world opportunities Cruise ship

14 Appeal of Emergency Medicine Make an immediate difference Life threatening injuries and illnesses Undifferentiated patient population Challenge of “anything” coming in Emergency / invasive procedures Safety net of healthcare

15 Appeal of Emergency Medicine Team approach Patient advocacy Open job market Academic opportunities Shift work / set hours Evolving specialty

16 Downside to Emergency Medicine Interaction with difficult, intoxicated, or violent patients Finding follow-up or care for uninsured Work in a “fishbowl” without 20/20 hindsight Working as a patient advocate Contract management groups Malpractice targets

17 The Lifestyle: Two Sides of A Coin Well defined shifts Usually not on call Part time employment possible Evenings and nights WeekendsHolidays

18 Subspecialties in Emergency Medicine Pediatric Emergency Medicine Toxicology Emergency Medical Services Sports Medicine

19 Areas of Expertise Toxicology Emergency medical services Mass gatherings Disaster management Wilderness medicine

20 Upcoming Areas of Emergency Medicine Observation units ED ultrasound International emergency medicine

21 Research Opportunities Broad range of subjects Limited amount of work published in our relatively new field Limited number of research mentors Limited number of clinical trials

22 Number of EM Physicians 4,945 Emergency Departments Need 32, ,000 ED physicians to staff In 2000, 20,164 ACEP members In 2000, 16,149 EM Board certified physicians

23 Emergency Medicine Organizations American College of Emergency Physicians American College of Osteopathic Emergency Medicine Society for Academic Emergency Medicine American Academy of Emergency Medicine Emergency Medicine Residents’ Association

24 Where to find more information

25 Emergency Medicine Journals Annals of Emergency Medicine Academic Emergency Medicine Journal of Emergency Medicine American Journal of Emergency Medicine Pediatric Emergency Care Several other Monthly Journals

26 EM Interest Groups Student run organization “Shadow Shifts” Journal club Suture clinic Radiology lab EKG clinic Lectures on EM topics

27 What to do to get in to Emergency Medicine for First and Second Year Students Observe in ED Summer research projects with EM staff EM interest group affiliation Be open to any medical specialty

28 Emergency Medicine Third Year Students See patients in ED on various rotations Obtain EM physician as mentor Start selecting fourth year rotations Try to rotate where you want to be Even for your “other rotations” Even for your “other rotations” Do a Radiology rotation in one of your earliest electives

29 Emergency Medicine Fourth Year Students Mandatory/Elective EM rotation Rotate where you want to be Make sure they know why you are there Make sure they know why you are there Consider extramural rotations Community experience Community experience Opportunity at a residency program Opportunity at a residency program SAEM maintains list of extramural EM rotations Letters of recommendation

30 Combined EM Residency Programs Emergency Medicine / Pediatrics Emergency Medicine / Internal Medicine Emergency Medicine / Internal Medicine / Critical Care

31 MONEY $$$$$ Emergency medicine is very variable Just about the middle of the physician pay scale Just about the middle of the physician pay scale “Academic” situations are less lucrative “Private groups” are most lucrative $150, is the norm Also varies on how much you work Also varies on how much you work “Contract groups” can be very tricky

32 How you get compensated Straight Hourly Rate---$90-150/hour Rural (slow) ED=less money Rural (slow) ED=less money RVU—relative value units (fee for service) You see a patient you get paid You see a patient you get paid Points based on Medicare tables for how valuable an intervention you have made Points based on Medicare tables for how valuable an intervention you have made Combination Hourly and RVU becoming the most common in private groups becoming the most common in private groups Unique “employee” set –up vs. being self-employed

33 Choosing A Specialty Fit your personality Decide between general or specialized field Look at all areas of interest Ignore gossip and commentary from outside the specialty you are investigating Commit to specialty you choose

34 American College of Emergency Physicians Member Services Department PO Box Dallas, TX Touch 5

35 Emergency Medicine Residents’ Association 1125 Executive Circle Irving, TX www.emra.org

36 ACOEP 142 East Ontario Street Suite 1250 Chicago, Illinois phone fax fax www.acoep.org