Future for EM

[Mx300]

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So I've been hearing that EM is getting more competitive. Mainly on this forum I might add. So naturally I don't like this as I'm interested in going down that road. Am I correct in assuming that currently it's at a moderate level of competition? And if it is, does anyone think that it would become even more competitive?

 

[Postictal Raiden]

EM is becoming fairly competitive. It's mainly due to 1) Adrenaline 2) pay:work hour ratio 3) media (NYMed, Untold Stories in ER, etc...). Looking at the residency match trend clearly reflects the increaing popularity of the field. I, too, am very interested in EM and I know it will be an uphill battle to match into a good EM program.

However, if there's anything we can learn from history, is that everything follows a cyclic path. What's considered a hot commodity today isn't necessarly that valuable tomorrow. Like CT, Cardio, Path, and Rad, the day will come when EM becomes saturated and jobs will be harder to find. Therefore, it's best to choose a field for the right reasons, so when sh_t hits the fan, you will at least be doing something you enjoy.

 

[Mx300]

So currently how competitive is it? Like is it to a point where you might not match? I'm not someone who's dead set on a top program, I just want to be in EM. And are top programs usually at level 1 trauma centers? And would you have to be at the top of ur class in med school, and have really high board scores to get into a good program?

 

[DrEnderW]

Totally obtainable from what I have seen from match statistics - ACGME or AOA.

There are some active members that are in EM residencies right now and hopefully they will chime in.

 

[sylvanthus]

EM is still totally doable if a person is around average with their stats. Granted, being a DO and going MD is a bit more difficult, but still within reach.

 

[cliquesh]

At least 5 people in my class failed to match EM, but nearly 20 did.

Last year 231 DOs matched AOA EM and 178 matched acgme EM. There were 4913 graduates last year.

 

[Mehd School]

Last year 231 DOs matched AOA EM and 178 matched acgme EM. There were 4913 graduates last year.

A more helpful number set would be how many applied EM. I don't think that exists, but still. Aligning total graduates with number matched in a certain specialty doesn't give much insight into how difficult it is to match.

 

[Elevencents]

A more helpful number set would be how many applied EM. I don't think that exists, but still. Aligning total graduates with number matched in a certain specialty doesn't give much insight into how difficult it is to match.

Last year 337 students marked EM as their first choice for 222 spots. This is only AOA residencies tho. For comparison sake, it was the most applicants per position outside of Gas and surgery specialties.

*from the GME match report 2012

 

[Mx300]

At least 5 people in my class failed to match EM, but nearly 20 did.

Last year 231 DOs matched AOA EM and 178 matched acgme EM. There were 4913 graduates last year.

I guess my next question is the quality of the applicants. For the ppl who have gone through the match, have u noticed whether the ppl who didnt match were ppl who were reaching for EM or were they ppl who had decent stats but just failed to land a spot? I guess it's a specific question but if someone has firsthand experience it would be interesting info.

 

[ToKingdomCome]

I guess my next question is the quality of the applicants. For the ppl who have gone through the match, have u noticed whether the ppl who didnt match were ppl who were reaching for EM or were they ppl who had decent stats but just failed to land a spot? I guess it's a specific question but if someone has firsthand experience it would be interesting info.

Does getting into an MD residency as a DO even matter for EM? I would think not since the fellowship opportunities aren't that interesting aside from the probable better training you'd receive.

Also average stats and you should be fine for EM in a DO residency?

 

[Jumpstartmy5HT]

IDK, I would be interested in doing some kind of toxicology fellowship.

Does getting into an MD residency as a DO even matter for EM? I would think not since the fellowship opportunities aren't that interesting aside from the probable better training you'd receive.

Also average stats and you should be fine for EM in a DO residency?

 

[Dr Yiot]

At least 5 people in my class failed to match EM, but nearly 20 did.

Last year 231 DOs matched AOA EM and 178 matched acgme EM. There were 4913 graduates last year.

to be fair though, some people do not apply intelligently. is it competetive? i would say moderately, but nothing in terms of gas/derm etc.

avg comlex for EM is around 500. nothing crazy. It is one of those specialties where your audition rotation is valued much higher than board scores.

some people tend to apply to 3 or 4 residencies cause they feel they were promised something or that their audition went well. Then they get burned.

 

[sylvanthus]

Does getting into an MD residency as a DO even matter for EM? I would think not since the fellowship opportunities aren't that interesting aside from the probable better training you'd receive.

Also average stats and you should be fine for EM in a DO residency?

Yup it matters, you can save a year by doing a 3 year instead of a 4 since all DO EM programs are 4 and you can now do critical care fellowships on the MD side and become board certified in critical care through IM CCM, Anesthesia CC, and surgery CC programs.

 

[sylvanthus]

to be fair though, some people do not apply intelligently. is it competetive? i would say moderately, but nothing in terms of gas/derm etc.

avg comlex for EM is around 500. nothing crazy. It is one of those specialties where your audition rotation is valued much higher than board scores.

some people tend to apply to 3 or 4 residencies cause they feel they were promised something or that their audition went well. Then they get burned.

This is extremely important to know. Never trust what programs tell you. They want to fill their spots period. Rank in the order YOU want to go and make sure you rank enough programs. Do not take any chances with ranking only a few programs because you were sure you would get in at a specific program.

 

[Dr Yiot]

yup its unfortunate but it does happen. you just have to be realistic with yourself and never trust anyone. apply to a lot of programs.

 

[NontradCA]

Looking at the GME data, 46% of the applicants who didn't match selected first choice specialty only once. For all applicants the mean number of contiguous first choice selections is less than 4. That seems very low; do people match only 1 or two programs (whichever they deem top) and just bet on the ACGME match?

 

[JediZero]

I made a big old post on DO's prospects of applying this year. Basically, at this point, EM is reasonably competitive, but still very accessible for those who are truly passionate about it. About 65-75% of people in both the DO and MD matches who rank at least one EM program match to one. You don't need great board scores or a long research CV, but you do need to be good with people, have strong letters and impress during your interviews and auditions.

Of course, you're asking about the future, and I can't tell you what that will be like. However, the forces that will probably be at play include a possible increase in popularity (it seems like there are suddenly a lot more people who want to go into it), the effect of the ACA (the Emergency Department already has to see everyone who comes in including uninsured, so even crappy insurance for all of them => huge boost in revenue => growth in EDs and/or EM Residencies?), and the up-and-down relationship between the AOA and ACGME (because God knows how that will play out). I think the biggest question for you and your classmates, regardless of specialty, will be how the boom in the number of applicants will affect you. At the time I was applying to Medical School ('09), there were ~3700 graduating DOs. Last year ('13), there were about 4900. That's a 1/3 increase over just four years. That's huge, and with all the new schools and expanding classes, it's just going to keep accelerating. Hopefully GME will find a way to keep pace, but just keep that in mind.

 

[cliquesh]

I made a big old post on DO's prospects of applying this year. Basically, at this point, EM is reasonably competitive, but still very accessible for those who are truly passionate about it. About 65-75% of people in both the DO and MD matches who rank at least one EM program match to one. You don't need great board scores or a long research CV, but you do need to be good with people, have strong letters and impress during your interviews and auditions.

Of course, you're asking about the future, and I can't tell you what that will be like. However, the forces that will probably be at play include a possible increase in popularity (it seems like there are suddenly a lot more people who want to go into it), the effect of the ACA (the Emergency Department already has to see everyone who comes in including uninsured, so even crappy insurance for all of them => huge boost in revenue => growth in EDs and/or EM Residencies?), and the up-and-down relationship between the AOA and ACGME (because God knows how that will play out). I think the biggest question for you and your classmates, regardless of specialty, will be how the boom in the number of applicants will affect you. At the time I was applying to Medical School ('09), there were ~3700 graduating DOs. Last year ('13), there were about 4900. That's a 1/3 increase over just four years. That's huge, and with all the new schools and expanding classes, it's just going to keep accelerating. Hopefully GME will find a way to keep pace, but just keep that in mind.

Yea, it's too bad. I don't even know how GME could posssibly keep up. First, our country is broke, so there isn't any federal funding available. Moreover, most hosptials are in the process of downsizing, so I doubt there is any private money available for residencies either. Secondly, there are only a finite number of hosptials that can provide adequate post graduate training, and I think most, if not all, of them have been utilized already.

 

[as1212559]

Coming from a 1st years perspective, I don't think EM is going to get any less competitive. It seems to me that almost half of my class or more express that EM is one of their top choices.

Granted first years know very little about the field for the most part, grades could be an issue for a few people, and not actually enjoying the ED could get in the way, but that is still a huge amount of interest in a particular field.

Part of it definitely comes from the mindset of the modern applicant. A lot of people are looking for a career that truly allows them a balanced lifestyle and EM is one that does that plus throws in easily $100K+ more a year than something like family medicine.

 

[Dharma]

Part of it definitely comes from the mindset of the modern applicant. A lot of people are looking for a career that truly allows them a balanced lifestyle and EM is one that does that plus throws in easily $100K+ more a year than something like family medicine.

I hear so many students quoting EM as being the pinnacle of lifestyle specialties. From the outside looking in, mostly only taking hours worked vs compensation into account (i.e. neglecting high burn out rates, hours spent catching up on sleep, associated health issues from shift work as your circadian cycle becomes progressively screwed, etc) one can easily be misled to believing it does provide balance (which for some, it actually does). They should really take the time to read this thread (somewhat of a classic thread over in the EM forums):

http://forums.studentdoctor.net/index.php?threads/em-is-not-a-lifestyle-specialty.898506/

 

[user3]

we all know that the number of DO applicants for ACGME is exploding, but is the quality of these applicants increasing that quickly as well? Even cliquesh admits that in his class, only a few people he knew scored 240+ on Step I, and other DO students (like dozitgetchahi) have said that there were not that many quality applicants (in terms of board scores) in their graduating classes.

 

[Mx300]

I hear so many students quoting EM as being the pinnacle of lifestyle specialties. From the outside looking in, mostly only taking hours worked vs compensation into account (i.e. neglecting high burn out rates, hours spent catching up on sleep, associated health issues from shift work as your circadian cycle becomes progressively screwed, etc) one can easily be misled to believing it does provide balance (which for some, it actually does). They should really take the time to read this thread (somewhat of a classic thread over in the EM forums):

http://forums.studentdoctor.net/index.php?threads/em-is-not-a-lifestyle-specialty.898506/

I don't know about most people but Im interested in EM because of the shift work. Not having a practice to run sounds very appealing and when ur off ur off. Also I like variety and family practice is not appealing because of the continuity of care. And I don't want to specialize. I don't think I'm gonna have this great lifestyle, but I think it would fit better than going to work at the same time every day, seeing the same thing..

 

[NontradCA]

I don't know about most people but Im interested in EM because of the shift work. Not having a practice to run sounds very appealing and when ur off ur off. Also I like variety and family practice is not appealing because of the continuity of care. And I don't want to specialize. I don't think I'm gonna have this great lifestyle, but I think it would fit better than going to work at the same time every day, seeing the same thing..

You will see less and less private FM docs in the future as groups are buying up practices. It's relatively easy to do. Furthermore, hospitalists have taken a lot of the call out of FM and it's possible to do the jack of all as a FP, but the continuity of care will still be there. Also, EM also has its bread and butter cases as well.

 

[Mx300]

Also, EM also has its bread and butter cases as well.

Well I know but I feel like it's different then FM. I've shadowed FM, and neurology and i didn't like the pace at all. When I worked in the ER it was busier and more interesting. I feel like EM is specialized FM in a way so to me it has alot of pros

 

[Mr Roboto]

Also I like variety and family practice is not appealing because of the continuity of care. ... I think it would fit better than going to work at the same time every day, seeing the same thing..

How much time have you spent in an actual ED? Do you realize you see the same things (SOB, CP, abd pain, flu/strep/common cold) for most cases?

 

[Mx300]

How much time have you spent in an actual ED? Do you realize you see the same things (SOB, CP, abd pain, flu/strep/common cold) for most cases?

I worked for a few months. And yes your right but it's not like it's scheduled and it's very quick. The atmosphere is just different. There's more of a team feeling then at a clinic idk i just felt like I fit in the ED

 

[Dharma]

Well I know but I feel like it's different then FM. I've shadowed FM, and neurology and i didn't like the pace at all. When I worked in the ER it was busier and more interesting. I feel like EM is specialized FM in a way so to me it has alot of pros

EM is most definitely not specialized FM. To oversimplify it: EP = acute generalist. FP = chronic generalist. There may be some small degree of overlap (more so in the fast track aspect in the ED) but they are two very different animals. Having spent a good deal of time working as a EM tech, I can say that the pace can be exciting at times but pretty darn chaotic and stressful as well. But, I only worked day shifts and assumed a lot less responsibility than the docs so it wasn't so bad (minus the poop wiping, which I never saw a physician do during my tenure).

Anyhow, you're young… you say now you don't care about working the graveyard shift… in 10, 15, 20 years a lot changes. Keep an open mind in terms of fields. Preconceived notions and even those opinions formed from shadow experiences (which only provide a very limited perspective btw) usually do not match up the reality of the everyday. Don't let those notions close doors before they really need to be shut. So, definitely keep an open mind.

 

[Dr Yiot]

dharma is right. most people think EM is a "lifestyle" specialty cause of no on call and 36 hour weeks. but those 36 hours can be graveyard and night shifts and if your new to the group you work for you will be doing the christmas days and thanksgivings the first few years. Dont forget the ED can get extremely busy at times. I shadowed in the ED and worked for a FP. I can tell you that the FP physician had less stress IMO. work 9-5 M-f and one or 2 saturday half days per month. Was never on call either other than the bieng called for a random prescription for some reason or another. There was also a much more predictable schedule and flow of patients throughout the day for the FP. saw usually around 25 patients a day. It was a great life honestly.

Althought there may be some overlap in a few of the smaller community hospitals in underserved areas I can assure you that EM physicians who work at level 1 trauma centers are not just taking care of chronic HTN or rhinitis. The work they do is much more stressful.

Keep an open mind, i came in to med school thinking surgery was it, and although I think of that sometimes I often times look at my wife and wish I could spend more time with her. With that in mind, surgery is no longer on my radar.

EM is a great career. Just go in with an open mind. who knows you might go in and surgery or radiology is the one thing you cannot see yourself doing.

 

[cliquesh]

My EM rotation is considered my "vacation" month intern year, and it definitely felt like one. The hours were great (fifteen 10 hour shifts a month, which is the same schedule as the EM residents), and the actual work wasnt very demanding. I can see why someone would want to do EM, especially if they didn't have a passion for anything.

 

[wook]

dharma is right. most people think EM is a "lifestyle" specialty cause of no on call and 36 hour weeks. but those 36 hours can be graveyard and night shifts and if your new to the group you work for you will be doing the christmas days and thanksgivings the first few years. Dont forget the ED can get extremely busy at times. I shadowed in the ED and worked for a FP. I can tell you that the FP physician had less stress IMO. work 9-5 M-f and one or 2 saturday half days per month. Was never on call either other than the bieng called for a random prescription for some reason or another. There was also a much more predictable schedule and flow of patients throughout the day for the FP. saw usually around 25 patients a day. It was a great life honestly.

Althought there may be some overlap in a few of the smaller community hospitals in underserved areas I can assure you that EM physicians who work at level 1 trauma centers are not just taking care of chronic HTN or rhinitis. The work they do is much more stressful.

Keep an open mind, i came in to med school thinking surgery was it, and although I think of that sometimes I often times look at my wife and wish I could spend more time with her. With that in mind, surgery is no longer on my radar.

EM is a great career. Just go in with an open mind. who knows you might go in and surgery or radiology is the one thing you cannot see yourself doing.

I agree EM is a great career!

I would second the caution given about the work hours (night shifts, holidays, etc). Your sleep cycle gets hosed up bouncing around from day to eve to night shifts. And the shift work is not just shift work. Often times, you may end up working more hours than you are officially compensated (e.g. documenting, critical patient that you are trying to keep alive, surge/disaster, etc). I have seen all of these. Depending on the type of ED you work at (e.g. small hospital versus large hospital versus tertiary care center), you may end up being extremely busy your entire shift without much downtime (ie no food break, no pee break, etc) as you are rocking and rolling the entire shift. The tertiary care centers tend to stay busy all the time, while the smaller and moderate hospitals may have some down time.

There are also physical safety issues with EM. For awhile there, I was having someone try to punch myself or one of the staff in the ED every week (for like 3 months). Now, it's down to once every couple of months. We had someone try to stab one of our nurses who was suicidal. I pulled a knife off of someone who was suicidal and had been checked for weapons. I have worked at places where firearms were discharged in the ED or near the ED. I have seen psychotic patients fight security, and attack ED staff. I have seen angry patients attack ED staff. I have seen drug seeking patients attack ED staff and police. I could go on and on about this. I think there have been several articles published about this (in the last decade), so I'll stop there.

Burnout with EM is being paid attention to. Initial studies concerning the high rate of burnout were not taken seriously, as the thought was that the people in the EM were not EM trained. A recent article (in the last 18 months) challenges that concept and it is listed as one of the top 5 burnout fields. Why that occurs is now being further evaluated.

With the caution being given, the job IS great. You get to help people when they often need it the most. You get to do procedures. You don't see the same thing every shift. You never know what's going to roll through the door. I would still choose this career, and still love it, but would encourage those thinking about this career get a full flavor of the positives AND the negatives.


Thanks.

Wook

 

[NurWollen]

I agree EM is a great career!

I would second the caution given about the work hours (night shifts, holidays, etc). Your sleep cycle gets hosed up bouncing around from day to eve to night shifts. And the shift work is not just shift work. Often times, you may end up working more hours than you are officially compensated (e.g. documenting, critical patient that you are trying to keep alive, surge/disaster, etc). I have seen all of these. Depending on the type of ED you work at (e.g. small hospital versus large hospital versus tertiary care center), you may end up being extremely busy your entire shift without much downtime (ie no food break, no pee break, etc) as you are rocking and rolling the entire shift. The tertiary care centers tend to stay busy all the time, while the smaller and moderate hospitals may have some down time.

There are also physical safety issues with EM. For awhile there, I was having someone try to punch myself or one of the staff in the ED every week (for like 3 months). Now, it's down to once every couple of months. We had someone try to stab one of our nurses who was suicidal. I pulled a knife off of someone who was suicidal and had been checked for weapons. I have worked at places where firearms were discharged in the ED or near the ED. I have seen psychotic patients fight security, and attack ED staff. I have seen angry patients attack ED staff. I have seen drug seeking patients attack ED staff and police. I could go on and on about this. I think there have been several articles published about this (in the last decade), so I'll stop there.

Burnout with EM is being paid attention to. Initial studies concerning the high rate of burnout were not taken seriously, as the thought was that the people in the EM were not EM trained. A recent article (in the last 18 months) challenges that concept and it is listed as one of the top 5 burnout fields. Why that occurs is now being further evaluated.

With the caution being given, the job IS great. You get to help people when they often need it the most. You get to do procedures. You don't see the same thing every shift. You never know what's going to roll through the door. I would still choose this career, and still love it, but would encourage those thinking about this career get a full flavor of the positives AND the negatives.


Thanks.

Wook

Anyone got links to these or similar articles? Not because I don't believe you, but because I'd be interested to read about this.

 

[wook]

Anyone got links to these or similar articles? Not because I don't believe you, but because I'd be interested to read about this.

ACEP has a good article discussing this (it has references in it)....http://www.acepnews.com/news/news-f...the-job/a76bdda307193d324f89de93ff00747f.html




J Emerg Med. 2012 Sep;43(3):523-31. doi: 10.1016/j.jemermed.2012.02.056. Epub 2012 May 24.
Workplace violence in emergency medicine: current knowledge and future directions.
Kowalenko T, Cunningham R, Sachs CJ, Gore R, Barata IA, Gates D, Hargarten SW, Josephson EB, Kamat S, Kerr HD, McClain A.
Source
Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
Abstract
BACKGROUND:
Workplace violence (WPV) has increasingly become commonplace in the United States (US), and particularly in the health care setting. Assaults are the third leading cause of occupational injury-related deaths for all US workers. Among all health care settings, Emergency Departments (EDs) have been identified specifically as high-risk settings for WPV.
OBJECTIVE:
This article reviews recent epidemiology and research on ED WPV and prevention; discusses practical actions and resources that ED providers and management can utilize to reduce WPV in their ED; and identifies areas for future research. A list of resources for the prevention of WPV is also provided.
DISCUSSION:
ED staff faces substantially elevated risks of physical assaults compared to other health care settings. As with other forms of violence including elder abuse, child abuse, and domestic violence, WPV in the ED is a preventable public health problem that needs urgent and comprehensive attention. ED clinicians and ED leadership can: 1) obtain hospital commitment to reduce ED WPV; 2) obtain a work-site-specific analysis of their ED; 3) employ site-specific violence prevention interventions at the individual and institutional level; and 4) advocate for policies and programs that reduce risk for ED WPV.
CONCLUSION:
Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

Acad Emerg Med. 2008 Dec;15(12):1268-74. doi: 10.1111/j.1553-2712.2008.00282.x. Epub 2008 Oct 25.
A survey of workplace violence across 65 U.S. emergency departments.
Kansagra SM, Rao SR, Sullivan AF, Gordon JA, Magid DJ, Kaushal R, Camargo CA Jr, Blumenthal D.
Source
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. [email protected]
Abstract
OBJECTIVES:
Workplace violence is a concerning issue. Healthcare workers represent a significant portion of the victims, especially those who work in the emergency department (ED). The objective of this study was to examine ED workplace violence and staff perceptions of physical safety.
METHODS:
Data were obtained from the National Emergency Department Safety Study (NEDSS), which surveyed staff across 69 U.S. EDs including physicians, residents, nurses, nurse practitioners, and physician assistants. The authors also conducted surveys of key informants (one from each site) including ED chairs, medical directors, nurse managers, and administrators. The main outcome measures included physical attacks against staff, frequency of guns or knives in the ED, and staff perceptions of physical safety.
RESULTS:
A total of 5,695 staff surveys were distributed, and 3,518 surveys from 65 sites were included in the final analysis. One-fourth of surveyed ED staff reported feeling safe sometimes, rarely, or never. Key informants at the sampled EDs reported a total of 3,461 physical attacks (median of 11 attacks per ED) over the 5-year period. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. In multivariate analysis, nurses were less likely to feel safe "most of the time" or "always" when compared to other surveyed staff.
CONCLUSIONS:
This study showed that violence and weapons in the ED are common, and nurses were less likely to feel safe than other ED staff.
Emerg Nurse. 2013 Jul;21(4):26-9.
Reducing violence and aggression in the emergency department.
Powley D.
Source
NHS Lothian District Nursing Services. [email protected]
Abstract
Emergency department (ED) staff, particularly nursing students and inexperienced nurses, are at risk of violence and aggression from patients. However, by reflecting on violent incidents, nurses can gain new knowledge, improve their practice and prepare themselves for similar incidents. This article refers to the Gibbs reflective cycle to analyse a violent incident involving a patient with mental health and alcohol-dependence problems that occurred in the author's ED. It also identifies strategies for nurses to pre-empt and defuse violent situations.

Int Emerg Nurs. 2013 Oct 7. pii: S1755-599X(13)00074-8. doi: 10.1016/j.ienj.2013.09.005. [Epub ahead of print]
Nurses' perceptions of the factors which cause violence and aggression in the emergency department: A qualitative study.
Angland S, Dowling M, Casey D.
Source
Emergency Department, Galway University Hospital, Ireland. Electronic address: [email protected].
Abstract
There has been an increase in violence and aggression in emergency departments (EDs) in recent years. Among professional health care workers, nurses are more likely than other staff members to be involved in aggressive incidents with patients or relatives. This research study was undertaken to determine nurses' perceptions of the factors that cause violence and aggression in the ED. Using a qualitative approach, twelve nurses working in an Irish ED were interviewed. Thematic analysis of the interview data revealed that environmental and communication factors contributed to violence and aggression in the ED. Participants perceived waiting times and lack of communication as contributing factors to aggression, and triage was the area in the ED where aggression was most likely to occur. A number of key recommendations arise from the study findings and they all relate to communication. To address the aggression that may arise from waiting times, electronic boards indicating approximate waiting times may be useful. Also, information guides and videotapes on the patient's journey through the ED may be of benefit. Consideration to the appointment of a communication officer in the ED and communication training for ED staff is also recommended.
Emerg Med J. 2013 Sep;30(9):758-62. doi: 10.1136/emermed-2012-201541. Epub 2012 Oct 4.
Violence in the emergency department: a multicentre survey of nurses' perceptions in Nigeria.
Ogundipe KO, Etonyeaku AC, Adigun I, Ojo EO, Aladesanmi T, Taiwo JO, Obimakinde OS.
Source
Division of Plastic and Reconstructive Surgery, Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria.
Abstract
BACKGROUND:
Emergency department (ED) violence is common and widespread. ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence. The violence is becoming increasingly common and lethal and many institutions are still improperly prepared to deal with it.
METHODS:
A questionnaire based survey of the perception of violence among nurses working in six tertiary hospitals' EDs across five states in Nigeria was conducted.
RESULTS:
81 nurses were interviewed with a male to female ratio of 1:4. Most were right about the definition of violence. About 88.6% of respondents have witnessed ED violence while 65.0% had been direct victims before. Nurses followed by doctors were the usual victims. The acts were carried out mostly by visitors to the ED. Men were usually responsible for the violence, which usually occurred in the evenings. Weapons were not commonly utilised: only 15.8% of the nurses had been threatened with a weapon over a 1-year period. The main perceived reasons for violence were overcrowded emergency rooms, long waiting time and inadequate system of security. All the institutions were lacking in basic strategies for prevention. While most of the nurses were not satisfied with the EDs that were considered not safe, few would wish for redeployment to other departments/units.
CONCLUSIONS:
There is a need to make the EDs safer for all users. This can be achieved by a deliberate management policy of 'zero' tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.

 

[wook]

Anyone got links to these or similar articles? Not because I don't believe you, but because I'd be interested to read about this.

Good discussion in an article in JAMA.....http://archinte.jamanetwork.com/article.aspx?articleid=1351351 Look at figure-1 burnout by specialty


Emerg Med Australas. 2013 Oct 9. doi: 10.1111/1742-6723.12135. [Epub ahead of print]
Review article: Burnout in emergency medicine physicians.
Arora M, Asha S, Chinnappa J, Diwan AD.
Source
St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Abstract
Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946-present) (search terms: 'Burnout, Professional' AND 'Emergency Medicine' AND 'Physicians'; 'Stress, Psychological' AND 'Emergency Medicine' AND 'Physicians') and EMBASE (1988-present) (search terms: 'Burnout' AND 'Emergency Medicine' AND 'Physicians'; 'Mental Stress' AND 'Emergency Medicine' AND 'Physicians') was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross-study (and cross-country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work-related (hours of work, years of practice, professional development activities, non-clinical duties etc.) and non-work-related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.
Emerg Med J. 2011 May;28(5):397-410. doi: 10.1136/emj.2009.082594. Epub 2010 Dec 1.
Emergency physicians accumulate more stress factors than other physicians-results from the French SESMAT study.
Estryn-Behar M, Doppia MA, Guetarni K, Fry C, Machet G, Pelloux P, Aune I, Muster D, Lassaunière JM, Prudhomme C.
Source
Department of Occupational Medicine, SCMT, Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Parvis Notre-Dame, 75004 Paris, France. [email protected]
Abstract
INTRODUCTION:
France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence.
METHODS:
The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists. It was made available online, and the two major associations of emergency physicians promoted its use. 3196 physicians filled out the questionnaire. Among them were 538 emergency physicians. To avoid bias, 1924 physicians were randomly selected from the total database to match the demographic characteristics of France's physician population: 42.5% women, 57.5% men, 8.2% < 35 years old, 33.8% 35-44 years old, 34.5% 45-54 years old and 23.6% ≥ 55 years old. The distribution of physicians in the 23 administrative regions and by speciality was also precisely taken into account. This representative sample was used to compare subgroups of physicians by speciality.
RESULTS:
The outcomes indicate that the intent to leave the profession (ITL) was quite prevalent across French physicians and even more so among emergency physicians (17.4% and 21.4% respectively), and burnout was highly prevalent (42.4% and 51.5%, respectively). Among the representative sample and among emergency physicians, work-family conflict (OR=4.47 and OR=6.14, respectively) and quality of teamwork (OR=2.21 and OR=5.44, respectively) were associated with burnout in a multivariate analysis, and these risk factors were more prevalent among emergency physicians than other types. A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (OR=3.92 among the physicians in the representative sample and OR=4.35 among emergency physicians), and burnout doubled the risk of ITL in multivariate analysis.
CONCLUSIONS:
In order to prevent the premature departure of French doctors, it is important to improve work-family balance, working processes through collaboration, multidisciplinary teamwork and to develop team training approaches and ward design to facilitate teamwork.
J Med Life. 2010 Jul-Sep;3(3):207-15.
Occupational burnout levels in emergency medicine--a nationwide study and analysis.
Popa F, Raed A, Purcarea VL, Lală A, Bobirnac G.
Source
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Abstract
INTRODUCTION:
The specificity of the emergency medical act strongly manifests itself on account of a wide series of psycho-traumatizing factors augmented both by the vulnerable situation of the patient and the paroxysmal state of the act. Also, it has been recognized that the physical solicitation and distress levels are the highest among all medical specialties, this being a valuable marker for establishing the quality of the medical act.
MATERIAL AND METHODS:
We have surveyed a total of 4725 emergency medical workers with the MBI-HSS instrument, receiving 4693 valid surveys (99.32% response rate). Professional categories included Emergency Department doctors (M-EMD), ambulance doctors (M-AMB), ED doctors with field work in emergency and resuscitation (including mobile intensive care units and airborne intensive care units) (D-SMU), medical nurses in Emergency Departments (N-EMD), medical nurses in the ambulance service (N-AMB), ED medical nurses with field activity in emergency and resuscitation (N-SMU), ambulance drivers (DRV) and paramedic (EMT). The n values for every category of subjects and percentage of system coverage (table 3) shows that we have covered an estimated total of 29.94% of the Romanian emergency medical field workers.
RESULTS:
MBI-HSS results show a moderate to high level of occupational stress for the surveyed subjects. The average values for the three parameters, corresponding to the entire Romanian emergency medical field were 1.41 for EE, 0.99 for DP and 4.47 for PA (95% CI). Average results stratified by professional category show higher EE average values (v) for the M-SMU (v=2.01, 95%CI) and M-EMD (v=2.21, 95% CI) groups corresponding to higher DP values for the same groups (vM-EMD=1.41 and vM-SMU=1.22, 95% CI). PA values for these groups are below average, corresponding to an increased risk factor for high degrees of burnout. Calculated PA values are 4.30 for the M-EMD group and 4.20 for the M-SMU group.
CONCLUSIONS:
Of all surveyed groups, our study shows a high risk of burnout consisting of high emotional exhaustion (EE) and high depersonalization (DP) values for Emergency Department doctors, Emergency, and Resuscitation Service doctors (M-SMU). Possible explanations for this might be linked to high patient flow, Emergency Department crowding, long work hours and individual parameters such as coping mechanisms, social development and work environment.
Ann Emerg Med. 2009 Jul;54(1):106-113.e6. doi: 10.1016/j.annemergmed.2008.12.019. Epub 2009 Feb 7.
Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine.
Kuhn G, Goldberg R, Compton S.
Source
Department of Emergency Medicine, Wayne State University, Detroit, MI 48201, USA. [email protected]
Abstract
STUDY OBJECTIVE:
Questions about burnout, career satisfaction, and longevity of emergency physicians have been raised but no studies have examined tolerance for uncertainty as a risk factor for burnout. Primary objectives of this study are to assess the role of uncertainty tolerance in predicting career burnout and to estimate the proportion of emergency physicians who exhibit high levels of career burnout.
METHODS:
A mail survey incorporating validated measures of career satisfaction, tolerance for uncertainty, and burnout was sent to a random sample of members of the American College of Emergency Physicians. Best- and worst-case scenarios of point estimates are provided to assess for the effect of nonresponse bias, and multivariable logistic regression was used to predict evidence of career burnout.
RESULTS:
One hundred ninety-three surveys were returned (response rate 43.1%). A high level of career burnout was exhibited in 62 (32.1%; best-worst case 13.8% to 64.1%) respondents. No demographic variables were associated with burnout status. The final model identified that high anxiety caused by concern for bad outcomes (odds ratio=6.35) was the strongest predictor of career burnout, controlling for all other variables.
CONCLUSION:
A large percentage of emergency physicians in this study, 32.1%, exhibited emotional exhaustion, which is the core symptom of burnout. Emotional exhaustion was not related to age or type of practice and was not mitigated by training in emergency medicine. Physicians studied did not feel anxiety because of general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. High anxiety caused by concern for bad outcomes was the strongest predictor of burnout. Despite exhibiting emotional exhaustion, the majority of respondents are satisfied with the career of emergency medicine.
Ann Emerg Med. 2008 Jun;51(6):714-722.e1. doi: 10.1016/j.annemergmed.2008.01.005. Epub 2008 Apr 8.
Career satisfaction in emergency medicine: the ABEM Longitudinal Study of Emergency Physicians.
Cydulka RK, Korte R.
Source
Department of Emergency Medicine MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA. [email protected]
Abstract
STUDY OBJECTIVE:
The primary objective of this study is to measure career satisfaction among emergency physicians participating in the 1994, 1999, and 2004 American Board of Emergency Medicine Longitudinal Study of Emergency Physicians. The secondary objectives are to determine factors associated with high and low career satisfaction and burnout.
METHODS:
This was a secondary analysis of a cohort database created with stratified, random sampling of 1,008 emergency physicians collected in 1994, 1999, and 2004. The survey consisted of 25 questions on professional interests, attitudes, and goals; 17 questions on training, certification, and licensing; 36 questions on professional experience; 4 questions on well-being and leisure activities; and 8 questions about demographics. Data were analyzed with a descriptive statistics and panel series regression modeling (Stata/SE 9.2 for Windows). Questions relating to satisfaction were scored with a 5-point Likert-like scale, with 1=not satisfied and 5=very satisfied. Questions relating to stress and burnout were scored with a 5-point Likert-like scale, with 1=not a problem and 5=serious problem. During analysis, answers to the questions "Overall, how satisfied are you with your career in emergency medicine?" "How much of a problem is stress in your day-to-day work for pay?" "How much of a problem is burnout in your day-to-day work for pay?" were further dichotomized to high levels (4, 5) and low levels (1, 2).
RESULTS:
Response rates from the original cohort were 94% (945) in 1994, 82% (823) in 1999, and 76% (771) in 2004. In 2004, 65.2% of emergency physicians reported high career satisfaction (4, 5), whereas 12.7% of emergency physicians reported low career satisfaction (1, 2). The majority of respondents (77.4% in 1994, 80.6% in 1999, 77.4% in 2004) stated that emergency medicine has met or exceeded their career expectations. Despite overall high levels of career satisfaction, one-third of respondents (33.4% in 1994, 31.3% in 1999, 31% in 2004) reported that burnout was a significant problem.
CONCLUSION:
Overall, more than half of emergency physicians reported high levels of career satisfaction. Although career satisfaction has remained high among emergency physicians, concern about burnout is substantial.