EM Specialists Outside the ER?

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chartero

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I am curious about the sort of opportunities emergency medicine specialists find outside the ER. I would imagine they're probably generally eligible for many posts in ambulatory urgent care... is this correct?

Of course there's the standard set of non-clinical roles any physician can look for in public health and policy, research, teaching and administration.

But I'm curious about EM-trained doctors bleeding into other clinical roles. Assume an EM-trained doctor isn't multiply boarded or eligible in FM or IM or something: to what extent can an EP look forward to moving on to work as a hospitalist? As a primary care physician, notionally a general practitioner, doing FM or IM sort of work work outside the hospital? In private practice in more focused niches, especially that might share something with emergency room practice... Pain medicine? Addiction medicine?

I understand demand for EM specialists in emergency rooms is high, and is likely to remain high as grandfathered specialists retire and more hospitals possibly move to phase out FMs and others and specialize their staffs in emerg. On the other hand, reforms to primary care overall could potentially reduce patient volumes coming in to the ER. And surely, at least some ER-qualified doctors eventually start looking at alternative forms and settings for practice, if only for personal, lifestyle reasons.

But I'm just an onlooker, and all I can do is make educated guesses from what sort of seems plausible. What other roles are EM-trained physicians actually taking out there, or would other posters here see them taking in the future?

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How about in "motor sports medicine"?? I'd actually really like to know how plausible it is for an EM doc to find a job (or even just as a hobby) working with an emergency response team at sporting events, like races. That seems like it would be pretty cool to be there in full support at an IRL, F1, Indy race what have you. Is this kinda thing common or more/less common than sports med asst'd with football, etc teams?
 
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How about in "motor sports medicine"?? I'd actually really like to know how plausible it is for an EM doc to find a job (or even just as a hobby) working with an emergency response team at sporting events, like races. That seems like it would be pretty cool to be there in full support at an IRL, F1, Indy race what have you. Is this kinda thing common or more/less common than sports med asst'd with football, etc teams?

Several of our faculty work with the Delphi safety team with the Indy Racing League. I think it can get tough with scheduling, but they get to travel, meet some cool people, and they look bada$$ in their bright orange fire suits.
 
Toxicology, hyberbarics/wound care, and neurocritical care come to mind.
 
Several of our faculty work with the Delphi safety team with the Indy Racing League. I think it can get tough with scheduling, but they get to travel, meet some cool people, and they look bada$$ in their bright orange fire suits.


Man that sounds like a sweet gig. Sooo, I guess it's doable, just a matter of finding the resource. Right now (aka the single years) the idea of travel excites me a lot more than it does push me away. I'm wondering how seasoned of an EM doc you need to be before any of these "teams" would pick you up. I mean if I trusted my skills enough after residency I think it'd be great to get involved with something like that early on in the career.
 
Many EM doctors I have met have also become heavily involved in academic medicine outside of the clinical teaching attending role. Such as Dean, medical directors, etc.

Also don't forget Hospital Administration, and PPO group administration.
 
Check the saem website. there is a long lis of fellowships.

also, people find many niches. exploration med, sports med, disaster med, large events....
 
I am curious about the sort of opportunities emergency medicine specialists find outside the ER. I would imagine they're probably generally eligible for many posts in ambulatory urgent care... is this correct?

Of course there's the standard set of non-clinical roles any physician can look for in public health and policy, research, teaching and administration.

But I'm curious about EM-trained doctors bleeding into other clinical roles. Assume an EM-trained doctor isn't multiply boarded or eligible in FM or IM or something: to what extent can an EP look forward to moving on to work as a hospitalist? As a primary care physician, notionally a general practitioner, doing FM or IM sort of work work outside the hospital? In private practice in more focused niches, especially that might share something with emergency room practice... Pain medicine? Addiction medicine?

I understand demand for EM specialists in emergency rooms is high, and is likely to remain high as grandfathered specialists retire and more hospitals possibly move to phase out FMs and others and specialize their staffs in emerg. On the other hand, reforms to primary care overall could potentially reduce patient volumes coming in to the ER. And surely, at least some ER-qualified doctors eventually start looking at alternative forms and settings for practice, if only for personal, lifestyle reasons.

But I'm just an onlooker, and all I can do is make educated guesses from what sort of seems plausible. What other roles are EM-trained physicians actually taking out there, or would other posters here see them taking in the future?

The bolded part of your statement kind of exhibits that you might be missing part of what people love about EM. Yes, we will work nights, weekends, and holidays for much (all?) of our careers. However, if I need a random Wednesday off to visit with a friend who is passing through town, attend a child's school play, run errands - it will likely be possible for me to get that particular day off. Hospitalists have a pretty good lifestyle (again with the nights, weekends, and holidays) but many hospitals are now requiring that they take overnight in-house call.

In my (humble, 4th year med student opinion) EM physicians are NOT qualified to work in pain and addiction medicine. Although these may be considered good lifestyle subspecialties because they are fairly 9-5 (if you only do outpt pain) the populations are incredibly challenging. Many patients are drug-seekers, hardened drug abusers who see their pain management physician as the key to legal narcotics. I love working with challenging patients, but I would not want to be in charge of long term follow up with them.
 
...Yes, we will work nights, weekends, and holidays for much (all?) of our careers...
Do other specialities really get these off? Now, I haven't hit the wards yet, but won't most specialities be working a lot of nights, weekends, and holidays anyways?

To put it another way - is EM really that much more focused on staffing during these times than any other speciality?
 
Do other specialities really get these off?

Actually, to a fair degree yes. Most specialties have and office based or outpatient component to their practice and won't schedule patients on holidays. They will only staff their departments/services on those days to cover inpatient and emergency services.
 
Actually, to a fair degree yes. Most specialties have and office based or outpatient component to their practice and won't schedule patients on holidays. They will only staff their departments/services on those days to cover inpatient and emergency services.
I get this. 4/5ths of the department may be home, but that just means you turn will come up every 5th weekend. And the hospital-based docs are still going to come in q6.

My point is that I thought it kinda came with the territory - as applicant, I expected that I'd be working a lot of weekends and holidays. Maybe I'll see more of what you're talking about over the next year.
 
Do other specialities really get these off? Now, I haven't hit the wards yet, but won't most specialities be working a lot of nights, weekends, and holidays anyways?

To put it another way - is EM really that much more focused on staffing during these times than any other speciality?

In my experience, YES. I have done almost all my rotations at tertiary care facilities, so I've been at the places that have the highest number of in-house attending physicians.

On holidays, evenings, and weekends:
Surgery - 1 in-house
IM - none in house
Neurology - HAH! (None in house)
Pediatrics - one pediatric ICU attending in house, one neonatologist in house
Family medicine (they have admitting privileges): none in-house
Psychiatry - none in house
Ob/gyn - 1 service attending in-house, often at least 1 private attending in house who is attending to a patient in active labor

In contrast, in the ER:
Weekends: 3 in house
Nights: 3 in house
Holidays: 3 in house
Regular days: 3-4 in house

There is absolutely no doubt in my mind that as an EM physician I will work far more nights, weekends, and holidays than my IM colleagues.

I always think it's interesting to hear from people pre-clinically and then afterwards. I never understood the huge shift in thinking that happens in third year until I experienced it. After 5 straight months of q4 call I realized that it was VERY important to me to have a job that kept me busy while I was at work, but that truly let me leave work when I went home for the evening.

I'm fully aware that I will be working nights, weekends, and holidays as well. The OP, however, didn't seem to understand the unique schedule of EM and its appeal so I wanted to clarify a little.
 
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In my experience, YES. I have done almost all my rotations at tertiary care facilities, so I've been at the places that have the highest number of in-house attending physicians...
Huh. Thanks for the detailed reply. Maybe it's just me, but working weekends and nights just doesn't seem that much of a cost compared to pulling all-nighters when on-call. And I'd much rather be at work when I'm at work.

...I always think it's interesting to hear from people pre-clinically and then afterwards. I never understood the huge shift in thinking that happens in third year until I experienced it...
I expect to get schooled, but I'm looking forward to it. Thanks again.
 
Working in motorsports could definitely be interesting. As a big car enthusiast I've thought about this before- not as a main gig, but perhaps something to do on the side for a while?
 
Yah, that would be cool! Why don't you start a fellowship? It could be motor-racing emergencies! You could spend a year following around NASCAR, drinking beer, and watching the cars go super-fast around and around in a circle hoping, praying that one of them crashes, and then, you could look like a real stud, running out there to either-

1. Call 911 and get them to a hospital

or

2. be the most qualified to declare them "not only sincerely dead, but really quite completely dead."

You could even combine your number 2 task into a "forensics fellowship." and you would be then be the most qualified person to decide whether it was the steering wheel that bashed their brains in or whether it was the crushed in roof of the car.

Dude, tell that to everyone in your interviews and I bet they'll let you start up that fellowship at their program.

Please forgive my sarcasm. I'm just trying to make a point.
 
You could become the doctor for a professional cycling team. Lots of broken bones, lacerations, road rash, viral infections, parasites...
 
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