Choosing Your Career Path in Emergency Medicine

They say Emergency Medicine has one of the highest rates of burnout among any medical specialty. This is likely due to demanding nature of our work in the ED, as well as our erratic shift hours. However, working endless shifts in a busy ED isn’t the only option for emergency physicians. There are a few interesting career paths within our specialty that may mix it up enough to keep you from flaming out early. Here’s a quick guide.

Academics

You can teach. You can do research. You can teach how to do research. You can research how to teach. You can research how to teach people how to do research on how to teach. The most important thing is finding your niche. Ultrasound, Wilderness Medicine, Space Medicine. Whatever path you choose, your time spent on your academic pursuits will buy down your shifts in the ED, which is like buying extra years of your life.

In academics you get to work with residents, which will keep you fresh, young, and up to date. And the best part? They will see all the patients. You get to show up to your shift and relax. Catch up on some emails. Plan your next vacation. Imagine sitting back as your residents hustle and bustle, buzzing around the ED doing all the work for you. Look at them go, these young hard-working doctors. Did that junior just walk by with a bloody chest tube in her hand? Maybe you should be paying more attention to what they are doing. Come to think of it, the senior hasn’t presented in a couple hours… is he just discharging patients on his own? Under your license? Okay, so you may have to see some of the patients just to double check their work. Not a big deal. They are still doing the bulk of the heavy lifting. Is that the rotator in room 3 telling a patient she three weeks to live? Her chief complaint said ‘medication refill’. Ok, so you’re gonna have to see every patient yourself. But wait that’s like 50 patients a shift. That’s way more than if you were working alone. And then there is the academic requirements??

Concierge Medicine

After years of slugging it out in a crowded, noisy cloud of evil foot smells you deserve a break. Some luxury. You deserve to choose your patients. Spend some quality time with them without that push to see that next patient. That ECG being waved in your face. That radiologist calling to tell you about a thyroid nodule. You want to form a connection with patients, listen to them, take the time to really figure out what they need, and then have the time and resources to deliver the quality of care you know you are capable of. Your patients will actually be satisfied. The only thing holding you back from that 100% patient satisfaction score is external forces. It’s not you. It’s the long wait times, short patient interactions, rude support staff, and condescending consultants. Not to mention your patient was placed two feet away from the guy who’s chief complaint was “SMOKED K2” and is currently tied to the stretcher, rocking the entire thing back and forth screaming, “Freeeddoommmmmm” while he urinates on himself. “How would you rate your experience here at our hospital?” Of course, your Press Ganey score is low.

In a boutique ED, you’ll finally have the resources and time to reach your full potential. Your patient has pain? You can finally take the time to do that nerve block. And in the meantime, they can tell you all about their grandson who wants to go to medical school. Your patients will leave satisfied with their holistic care.

Though what happens if they expect more satisfaction after that? What if they get used to their satisfaction, and forget they’re satisfied, and become unsatisfied. What if they’re no longer happy with the temporary pain relief and they want a cure for their pain. Yes they’ve had it for over 40 years, but they pay thousands of dollars a month for this service, so they can make those kind of demands and expect results. And what about their grandson they told you about. Can you get him into medical school? And their golf swing has never been good. Is there a pill for that? “Doc, do you have anything that will help my cat, Brioche? He died 6 years ago. I’ll bring him in with me at my next visit.” They will want, no, they will demand a cure for their chronic discontentment. Can you cure the process of aging itself? Is there an injection that will make them feel 20 again? And they can make those demands because they pay thousands of dollars a month for this service.

And you can’t get away from them because that is your only patient for the day. There are no distractions, there are no other patients to be seen and you are the only one to blame for their sub-par service. There is no phone ringing with a radiologist waiting to tell you about a thyroid nodule. Where is that K2 guy when you need him? Can he come scare this lady away? Please, someone wave an ECG in my face!

Telemedicine

It’s like those ads that promise you can make ten thousand dollars from the comfort of your own couch, but this isn’t a pyramid scheme, this is real. Imagine it: waking up when you want, taking your time to make coffee and a nice breakfast, your home is your office, you get to spend all day in comfort. The comfort of your home. The couch. The kitchen. Back to your couch. Maybe step outside for a bit. Then maybe the kitchen again. Then. Whatever. At least you’re not at work. Why are you staring in the fridge all of a sudden? How long has your dog been sitting there watching you? Ok, let’s be productive. These are you work hours. Time to work. No phone calls yet, so let’s see, maybe read something? Write that paper you said you were gonna write. I wonder what they’re doing at work right now? Maybe you should call them and see if it’s busy. No that’s a stupid idea, the whole goal was to get away from that place. Oh, did the phone just ring? No, just a passing ambulance. Now just silence. Your dog is still staring at you. Maybe you should take her for a walk. Oh, was that a call? No. Just more silence.

Administration

Become a leader. Focus on the big picture. Make the big decisions. You get to rise above the masses. With a snap of your fingers, you can change their lives. Oh, you don’t like our EMR? Shazam! Epic is here. And just like that, you are a hero. Your face will be chiseled on the.. what’s that? There are some hiccups with the Epic rollout? People don’t appreciate all the safe checks we integrated into the system? Ok, so there’s some things that need fixing. That’s what you’re here for, you’re the big picture fix… what’s that? Four attendings are quitting? That’s okay. Everything is okay. Steady the ship. Land the planes. That’s what you’re here for. You’re a leader. Remember your training. You deliver performance-based collaboration and idea-sharing. You intrinsically promote just-in-time best practices. You… uh… you objectively communicate… what’s that? The entire nursing staff just staged a walk-out? Well then.

Cruise Medicine

The open seas. Hundreds of elderly patients with Norovirus. Maybe not.

Open a Restaurant

Maybe this whole medicine thing was a mistake. Why not open a restaurant? It would be cool to have a business that’s your own. Your hard work pays off in tangible ways. Yeah, its long hours, but you won’t mind them, ‘cause it’s your baby. It’s a reflection of you. You look around and all you see are smiles and conversation and why are those people at the front yelling? Oh they’ve been waiting an hour for a table and can’t get one? Well, we’re working as hard as we can seeing patients, I meant customers, ma’am. No need to yell. Oh, this guy wasn’t satisfied with his dish. Well sir, this is a hospital, not a.. oh wait.