Emergency Medicine

A Career with many A Career with many OptionsOptions

Kevin Biese, MD

Assistant Residency DirectorAssistant Residency DirectorMedical Student Clerkship DirectorMedical Student Clerkship DirectorDepartment of Emergency Medicine Department of Emergency Medicine

University of North CarolinaUniversity of North Carolina

A Unique Set of Circumstances:

1960’s 1960’s Increasingly mobile populationIncreasingly mobile population Increase in unscheduled careIncrease in unscheduled careErratic ED care Erratic ED care Unsupervised Junior physicians in EDUnsupervised Junior physicians in EDViet Nam War ~Viet Nam War ~>> improved Trauma Care improved Trauma Care

A New Model:

The Alexandria Plan The Alexandria Plan circa 1961circa 1961James D. Mills and 3 ColleaguesJames D. Mills and 3 Colleagues 11stst Full-time ED group Full-time ED groupContinuously available first contact Continuously available first contact

providersproviders

A New Model:

The Pontiac PlanThe Pontiac PlanPontiac and Flint MichiganPontiac and Flint MichiganMaintain office practice + Provide Maintain office practice + Provide

Emergency Care Emergency Care Less popular modelLess popular model

James D. Mills, MDcirca 1970

A Specialty is Born

First National Meeting of EM First National Meeting of EM PhysiciansPhysicians 19681968Arlington, VAArlington, VA32 attendees from 18 states32 attendees from 18 states Incorporated as a National AssociationIncorporated as a National Association

The American College of Emergency The American College of EmergencyPhysiciansPhysicians

ACEP: November 1968

Future:

A Supply and Demand A Supply and Demand EquationEquation

The Need for Emergency Physicians

Demand Side Economics

On the Demand SideOn the Demand Side

Phase One ACEP’s Workforce StudyPhase One ACEP’s Workforce Studycompleted October 1997completed October 1997

Phase Two currently underwayPhase Two currently underway Solid data defining EM as a Solid data defining EM as a

““ shortage specialty”shortage specialty”

Workforce in Emergency Medicine

Places = 24,548 FTEPlaces = 24,548 FTE Faces= 36,990 PhysiciansFaces= 36,990 Physicians Physician/ FTE ratio = 1.51 Physician/ FTE ratio = 1.51 :: 1 1 54% 54% BCEMBCEM Physicians Physicians

On the Supply SideOn the Supply Side

Attracting dedicated and involved Attracting dedicated and involved medical studentsmedical students

Excellent performance in the Match Excellent performance in the Match Job opportunities still strongJob opportunities still strong

Current Status of Residency Training in US

135 Categorical EM Training 135 Categorical EM Training ProgramsPrograms

Number of programs more than Number of programs more than doubled since 1980doubled since 1980

1-3 Programs, 2-4 Programs, 1-4 1-3 Programs, 2-4 Programs, 1-4 Programs Programs

Looking Beyond Residency

Fellowship TrainingFellowship Training Private PracticePrivate Practice AdministrationAdministration

AcademicsAcademics Other creative optionsOther creative options

Fellowships in EM

PediatricsPediatrics

Medical Medical ToxicologyToxicology

Sports MedicineSports Medicine

Critical Care/IMCritical Care/IM

ResearchResearch

AdministrationAdministration

EMSEMS

InternationalInternational

Research Fellowship Select your mentorSelect your mentor

Work well togetherWork well together ExperiencedExperienced

Develop your projectDevelop your project Your ideaYour idea Mentor’s projectMentor’s project

Apply for fundingApply for funding GovernmentGovernment FoundationsFoundations CorporateCorporate

Pediatric EM Fellowship

Board Certification Board Certification by ABEM and AAPby ABEM and AAP

2 or 3 years2 or 3 years Job OpportunitiesJob Opportunities

Expert in EM groupExpert in EM group Work in Pediatric EDWork in Pediatric ED Academic facultyAcademic faculty

Medical Toxicology Fellowship

Board certificationBoard certification Job OpportunitiesJob Opportunities

Expert in EM groupExpert in EM group Manage an Manage an

inpatient toxicology inpatient toxicology serviceservice

Poison ControlPoison Control Academic facultyAcademic faculty

Sports Medicine Fellowship

Board Certification Board Certification by ABEM and by ABEM and ABFPABFP

Career Career OpportunitiesOpportunities Academic EMAcademic EM Sports MedicineSports Medicine Inpatient serviceInpatient service

Administration Fellowship

EM group or agency EM group or agency Individually designedIndividually designed Career OpportunitiesCareer Opportunities

Group LeaderGroup Leader Leader in medical Leader in medical

organizationsorganizations GovernmentGovernment

Emergency Medical Services (EMS) Fellowship

Not Boarded Not Boarded Career Career

OpportunitiesOpportunities EMS Director EMS Director Group EMS Group EMS

DirectorDirector Paramedic Paramedic

EducationEducation EMS policy EMS policy

makermaker

Critical Care Fellowship

New idea in EMNew idea in EMCurrently EM grads cannot sit the CC Currently EM grads cannot sit the CC

boardsboards Available to EM/ IM graduates Available to EM/ IM graduates New TrackNew Track

IM + EM + Critical Care = 6 yearsIM + EM + Critical Care = 6 yearsTriple certificationTriple certification

Educational Fellowship

Specialized training in teaching Specialized training in teaching methodologymethodology

Specialty specificSpecialty specific ACEP/EMFACEP/EMF EM residencyEM residency

University basedUniversity based Degree programDegree program Medical schoolMedical school

International Emergency Medicine

Travel the World

Uniquely trained to be useful in underdeveloped areas

Private Practice Join a GroupJoin a Group

LucrativeLucrative PartnershipPartnership

Profit sharingProfit sharing Managed CareManaged Care

MoonlightMoonlight Control of scheduleControl of schedule VarietyVariety Employee statusEmployee status Independent contractorIndependent contractor

Administration

EM Group leaderEM Group leader Hospital committeesHospital committees Hospital administratorHospital administrator EMS directorEMS director Education coordinatorEducation coordinator Politics of EMPolitics of EM

Specialty societiesSpecialty societies GovernmentGovernment

Academics

Academic Practice of EM

TeachingTeaching Research in EMResearch in EM

Basic Science ResearchBasic Science Research Clinical ResearchClinical Research

Contribute to medical literatureContribute to medical literature Peer reviewed journalsPeer reviewed journals Textbook chaptersTextbook chapters

Care of patients in the EDCare of patients in the ED Supervise residents and medical studentsSupervise residents and medical students

“I like to teach” academics

Clinical TrackClinical Track Affiliated Teaching Affiliated Teaching

sitesite Teach EMT’s, Nurses, Teach EMT’s, Nurses,

etcetc Community TeachingCommunity Teaching

Other Options

Cruise Ship Cruise Ship MedicineMedicine

Locum tenensLocum tenens AgencyAgency On your ownOn your own

EM Organizations

ACEPACEPSAEMSAEMEMRAEMRAAAEMAAEMABEMABEM

21,000 members21,000 members Fellowship available (FACEP) Fellowship available (FACEP) Policy Making Body for EMPolicy Making Body for EM Active EM Lobby Active EM Lobby Major Educator of EM Physicians Major Educator of EM Physicians

Scientific Assembly and Research Scientific Assembly and Research ForumForum

Society for Academic Emergency Medicine (SAEM)

Teaching & ResearchTeaching & Research Annual meeting - MayAnnual meeting - May Students may joinStudents may join

Committee and task Committee and task force force

Medical student Medical student sessionssessions

Medical student Medical student resourcesresources

Emergency Medicine Residents’ Association (EMRA)

Independent OrganizationIndependent Organization Medical student sectionMedical student section Resources for studentsResources for students

Printed materialsPrinted materials CommitteesCommittees Web site www.emra.orgWeb site www.emra.org

Leadership roles for Leadership roles for medical studentsmedical students

American Academy of Emergency medicine

Represents Represents practitioners in practitioners in Emergency Emergency MedicineMedicine

Annual educational Annual educational meetingsmeetings

Medical student Medical student section availablesection available

American Board of Emergency Medicine (ABEM)

EM licensing and EM licensing and CertificationCertification

Member of the Member of the American Board of American Board of Medical SpecialtiesMedical Specialties

Certification Procedure

Finish ResidencyFinish Residency Written Certification ExaminationWritten Certification Examination

Given in the fall after residency graduationGiven in the fall after residency graduation Oral ExaminationOral Examination

Series of vignettes of common ED patientsSeries of vignettes of common ED patients May take after passing written examMay take after passing written exam

Continuous certification process Continuous certification process lifetime learninglifetime learning

Emergency Medicine Journals

Why I Picked EM

Fresh patientsFresh patients See lots of cool stuffSee lots of cool stuff Make a difference in an immediate Make a difference in an immediate

wayway International workInternational work Structured lifeStructured life

How to Get Involved

EMIG ActivitiesEMIG Activities Shadow in the EDShadow in the ED

Contact Tracy ParishContact Tracy Parish EMIG LeadershipEMIG Leadership Research OpportunitiesResearch Opportunities Contact us earlyContact us early

Conclusions

EM offers an exciting and EM offers an exciting and rewarding career with rewarding career with many options for life long many options for life long learning and personal learning and personal satisfaction satisfaction