1 introduction to emergency medicine slides courtesy of american college of emergency physicians
TRANSCRIPT
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Introduction to Emergency Introduction to Emergency Medicine Medicine
Slides Courtesy ofSlides Courtesy of
American College of Emergency American College of Emergency PhysiciansPhysicians
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Everything you want to know about Everything you want to know about Emergency Medicine-and dare to askEmergency Medicine-and dare to ask
John Cunha, DOJohn Cunha, DO
Attending PhysicianAttending Physician
Holy Cross HospitalHoly Cross Hospital
Ft. Lauderdale, FLFt. Lauderdale, FL
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Lecture ObjectivesLecture Objectives
Convey an understanding of the field of Convey an understanding of the field of Emergency MedicineEmergency Medicine
Discuss pros and cons of specialtyDiscuss pros and cons of specialty
Describe emergency medicine residency Describe emergency medicine residency training training
Monetary considerationsMonetary considerations
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History of Emergency MedicineHistory of Emergency Medicine
Emergency DepartmentsEmergency Departments Staffed by physicians of various backgroundsStaffed by physicians of various backgrounds No specialty trainingNo specialty training
American College of Emergency PhysiciansAmerican College of Emergency Physicians Established 1968Established 1968
ACOEPACOEP Established in 1975Established in 1975
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Emergency Medicine ResidencyEmergency Medicine Residency
First “resident” - 1969First “resident” - 1969
First residencies - 1970First residencies - 1970 University of CincinnatiUniversity of Cincinnati
Emergency Medicine Residents’ Association - Emergency Medicine Residents’ Association - 19741974
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Emergency Medicine ResidencyEmergency Medicine Residency
Emergency Medicine ResidenciesEmergency Medicine Residencies 1983 - 66 programs1983 - 66 programs 1990 - 84 programs1990 - 84 programs 2007-36 AOA programs, 138 AMA programs2007-36 AOA programs, 138 AMA programs Multiple “combined programs”Multiple “combined programs”
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Specialty Selection Specialty Selection Top Ten Leading Causes of Death in the U.S.Top Ten Leading Causes of Death in the U.S.
Heart Disease: Heart Disease: 726,974726,974Cancer: Cancer: 539,577539,577Stroke: Stroke: 159,791159,791Chronic Obstructive Pulmonary Disease: Chronic Obstructive Pulmonary Disease: 109,029109,029Accidents: Accidents: 95,64495,644Pneumonia/Influenza: Pneumonia/Influenza: 86,44986,449Diabetes: Diabetes: 62,63662,636Suicide: Suicide: 30,53530,535Nephritis, Nephrotic Syndrome, and Nephrosis Nephritis, Nephrotic Syndrome, and Nephrosis 25,33125,331Chronic Liver Disease and Cirrhosis: Chronic Liver Disease and Cirrhosis: 25,17525,175
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Exciting Patient EncountersExciting Patient Encounters
Motor vehicle versus pedestrian accidentMotor vehicle versus pedestrian accident
Acute myocardial infarctionAcute myocardial infarction
24 yo with GSW to chest24 yo with GSW to chest
66 yo with CPR in progress66 yo with CPR in progress
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What’s Your Diagnosis ?What’s Your Diagnosis ?
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What’s Your Diagnosis ?What’s Your Diagnosis ?
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Not So Exciting Patient EncountersNot So Exciting Patient Encounters
5 yo with Asthma5 yo with Asthma
75 yo with Emphysema75 yo with Emphysema
45 yo alcoholic vomiting blood45 yo alcoholic vomiting blood
3 week old with fever of 1043 week old with fever of 104
37 week pregnant female with vaginal 37 week pregnant female with vaginal bleedingbleeding
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Everyday Non-emergent Patient EncountersEveryday Non-emergent Patient Encounters
25 yo with a rash 25 yo with a rash
Homeless patient with no other physicianHomeless patient with no other physician
Back pain for 3 monthsBack pain for 3 months
Migraine headacheMigraine headache
Ran out of medicinesRan out of medicines
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Employment OpportunitiesEmployment Opportunities
Urban, rural, or suburban hospitalsUrban, rural, or suburban hospitals
Teaching or community hospitalsTeaching or community hospitals Trauma or not-traumaTrauma or not-trauma
Traveling (Locum tenens) physiciansTraveling (Locum tenens) physicians
International opportunitiesInternational opportunities
Third world opportunitiesThird world opportunities
Cruise shipCruise ship
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Appeal of Emergency MedicineAppeal of Emergency Medicine
Make an immediate differenceMake an immediate difference
Life threatening injuries and illnessesLife threatening injuries and illnesses
Undifferentiated patient populationUndifferentiated patient population
Challenge of “anything” coming inChallenge of “anything” coming in
Emergency / invasive proceduresEmergency / invasive procedures
Safety net of healthcareSafety net of healthcare
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Appeal of Emergency MedicineAppeal of Emergency Medicine
Team approachTeam approach
Patient advocacyPatient advocacy
Open job marketOpen job market
Academic opportunities Academic opportunities
Shift work / set hoursShift work / set hours
Evolving specialtyEvolving specialty
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Downside to Emergency MedicineDownside to Emergency Medicine
Interaction with difficult, intoxicated, or violent Interaction with difficult, intoxicated, or violent patientspatients
Finding follow-up or care for uninsuredFinding follow-up or care for uninsured
Work in a “fishbowl” without 20/20 hindsight Work in a “fishbowl” without 20/20 hindsight
Working as a patient advocateWorking as a patient advocate
Contract management groupsContract management groups
Malpractice targetsMalpractice targets
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The Lifestyle:The Lifestyle:Two Sides of A CoinTwo Sides of A Coin
Well defined shiftsWell defined shifts
Usually not on callUsually not on call
Part time employment possiblePart time employment possible
Evenings and nightsEvenings and nights
WeekendsWeekends
Holidays Holidays
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Subspecialties in Emergency Subspecialties in Emergency MedicineMedicine
Pediatric Emergency MedicinePediatric Emergency Medicine
ToxicologyToxicology
Emergency Medical ServicesEmergency Medical Services
Sports MedicineSports Medicine
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Areas of ExpertiseAreas of Expertise
ToxicologyToxicology
Emergency medical servicesEmergency medical services
Mass gatheringsMass gatherings
Disaster management Disaster management
Wilderness medicineWilderness medicine
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Upcoming Areas of Upcoming Areas of Emergency MedicineEmergency Medicine
Observation unitsObservation units
ED ultrasoundED ultrasound
International emergency medicineInternational emergency medicine
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Research OpportunitiesResearch Opportunities
Broad range of subjectsBroad range of subjects
Limited amount of work published in our Limited amount of work published in our relatively new fieldrelatively new field
Limited number of research mentorsLimited number of research mentors
Limited number of clinical trialsLimited number of clinical trials
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Number of EM PhysiciansNumber of EM Physicians
4,945 Emergency Departments4,945 Emergency Departments
Need 32,000 - 37,000 ED physicians to staffNeed 32,000 - 37,000 ED physicians to staff
In 2000, 20,164 ACEP membersIn 2000, 20,164 ACEP members
In 2000, 16,149 EM Board certified physicians In 2000, 16,149 EM Board certified physicians
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Emergency Medicine OrganizationsEmergency Medicine Organizations
American College of Emergency PhysiciansAmerican College of Emergency Physicians
American College of Osteopathic Emergency American College of Osteopathic Emergency MedicineMedicine
Society for Academic Emergency MedicineSociety for Academic Emergency Medicine
American Academy of Emergency MedicineAmerican Academy of Emergency Medicine
Emergency Medicine Residents’ AssociationEmergency Medicine Residents’ Association
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Where to find more informationWhere to find more information
www.acoep.orgwww.acoep.org
www.acep.orgwww.acep.org
www.emra.orgwww.emra.org
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Emergency Medicine JournalsEmergency Medicine Journals
Annals of Emergency MedicineAnnals of Emergency Medicine
Academic Emergency MedicineAcademic Emergency Medicine
Journal of Emergency MedicineJournal of Emergency Medicine
American Journal of Emergency MedicineAmerican Journal of Emergency Medicine
Pediatric Emergency CarePediatric Emergency Care
Several other Monthly JournalsSeveral other Monthly Journals
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EM Interest GroupsEM Interest Groups
Student run organizationStudent run organization
““Shadow Shifts”Shadow Shifts”
Journal clubJournal club
Suture clinicSuture clinic
Radiology labRadiology lab
EKG clinicEKG clinic
Lectures on EM topicsLectures on EM topics
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What to do to get in to Emergency What to do to get in to Emergency Medicine for First and Second Year Medicine for First and Second Year
StudentsStudents
Observe in EDObserve in ED
Summer research projects with EM staffSummer research projects with EM staff
EM interest group affiliationEM interest group affiliation
Be open to any medical specialtyBe open to any medical specialty
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Emergency MedicineEmergency MedicineThird Year StudentsThird Year Students
See patients in ED on various rotationsSee patients in ED on various rotations
Obtain EM physician as mentorObtain EM physician as mentor
Start selecting fourth year rotationsStart selecting fourth year rotations
Try to rotate where you want to beTry 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 Do a Radiology rotation in one of your earliest electiveselectives
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Emergency MedicineEmergency MedicineFourth Year StudentsFourth Year Students
Mandatory/Elective EM rotationMandatory/Elective EM rotation
Rotate where you want to beRotate where you want to be Make sure they know why you are thereMake sure they know why you are there
Consider extramural rotations Consider extramural rotations Community experienceCommunity experience Opportunity at a residency program Opportunity at a residency program
SAEM maintains list of extramural EM rotationsSAEM maintains list of extramural EM rotations
Letters of recommendationLetters of recommendation
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Combined EM Residency ProgramsCombined EM Residency Programs
Emergency Medicine / PediatricsEmergency Medicine / Pediatrics
Emergency Medicine / Internal MedicineEmergency Medicine / Internal Medicine
Emergency Medicine / Internal Medicine / Emergency Medicine / Internal Medicine / Critical CareCritical Care
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MONEY $$$$$MONEY $$$$$
Emergency medicine is very variableEmergency medicine is very variable Just about the middle of the physician pay scaleJust about the middle of the physician pay scale
““Academic” situations are less lucrativeAcademic” situations are less lucrative
““Private groups” are most lucrativePrivate groups” are most lucrative
$150,000-400000 is the norm$150,000-400000 is the norm Also varies on how much you workAlso varies on how much you work
““Contract groups” can be very trickyContract groups” can be very tricky
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How you get compensatedHow you get compensated
Straight Hourly Rate---$90-150/hourStraight Hourly Rate---$90-150/hour Rural (slow) ED=less money Rural (slow) ED=less money RVU—relative value units (fee for service)RVU—relative value units (fee for service) You see a patient you get paidYou see a patient you get paid Points based on Medicare tables for how valuable Points based on Medicare tables for how valuable
an intervention you have madean intervention you have madeCombination Hourly and RVUCombination Hourly and RVU becoming the most common in private groupsbecoming the most common in private groupsUnique “employee” set –up vs. being self-employedUnique “employee” set –up vs. being self-employed
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Choosing A SpecialtyChoosing A Specialty
Fit your personalityFit your personality
Decide between general or specialized fieldDecide between general or specialized field
Look at all areas of interestLook at all areas of interest
Ignore gossip and commentary from outside the Ignore gossip and commentary from outside the specialty you are investigatingspecialty you are investigating
Commit to specialty you chooseCommit to specialty you choose
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American College ofAmerican College ofEmergency PhysiciansEmergency Physicians
Member Services DepartmentMember Services Department
PO Box 619911PO Box 619911
Dallas, TX Dallas, TX 75261-991175261-9911
1-800-798-1822 Touch 51-800-798-1822 Touch 5
www.acep.orgwww.acep.org
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Emergency MedicineEmergency MedicineResidents’ AssociationResidents’ Association
1125 Executive Circle1125 Executive Circle
Irving, TX 75038-2522Irving, TX 75038-2522
1-972-550-09201-972-550-0920
www.emra.orgwww.emra.org
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ACOEPACOEP
142 East Ontario Street142 East Ontario StreetSuite 1250Suite 1250Chicago, Illinois 60611Chicago, Illinois 60611
phone 312.587.3709 phone 312.587.3709 800.521.3709 800.521.3709 fax 312.587.9951fax 312.587.9951www.acoep.orgwww.acoep.org