a career in emergency medicine

So you want to be an ER doc. Four years of premed, four years of medical school and four years on EM residency don't intimidate you. Upwards of a 1/4 million dollars of debt, no problem. The glamour of body fluids extruding from every orifice, working 24/7/365, bring it on.

Back in the mid 70's, I suggested to my faculty adviser, an endocrinologist trained at the world's best medical school, that I wished to become an EM doctor. He laughed and explained that a doctor worked in ER's for extra cash while training in medicine, surgery, pediatrics or OB/GYN. I had performed well in my clerkships, especially surgery, and he encouraged me to apply for surgical residencies. When I insisted that EM was a new but real specialty he told me that I was wasting my career.

When I graduated from medical school, there were only 18 residencies in EM in the 50 states. New England had zero EM programs. I visited at least half of all the programs and was fortunate to train in NYC. Each year of the program had only three residents. We worked long hours with little "adult" supervision. The experience was humbling but exciting. Gun shots, stabbings, MVC's gave ample chances to cut, suture, drill and get up to one's elbows in gore.

The first board certification exams in EM became a reality in the late 70's. I completed my residency in 1980 and became board certified in 1981. Unique at the time, the EM boards were in two parts, written and an oral examination. EM also pioneered the concept of having to recertify in the specialty every ten years.

Thirty years later there are more than 120 EM residencies. The attraction to the field is still the hands-on nature of the work. The adrenaline rush appeals to some, while others like the idea of working 36 hours a week for a decent remuneration and no beepers or on-call schedule. Nights, weekends and holidays must be covered but when you are off, you are truly free.

As mentioned in prior posts, the reality of working different shifts and the grinding nature of the sheer volume of patients, makes for a high degree of career burnout. It is imperative that the EM physician take care of him or her self. Proper diet, exercise, and a supportive home life all help to relieve the stress. Sharing with your fellow ER docs and mentoring of the young grads by the more experienced docs also contribute to career longevity.

The specialty of EM has expanded to include a number of subspecialties. Pediatrics, toxicology, diving, travel and cruise ship branches allow for greater flexibility in one's career. EM has become a very popular choice for medical students. EM has cool toys to play with. Ultrasound, and fiberoptics have become standard in most ER's.

You are a good student. You want to do something meaningful in life. You wish to make a difference in the lives of others. Medicine may be the best path for you. If you also like extreme sports, live for the rush of stress hormones coursing through your veins and can multitask without breaking a sweat, EM may be for you.