Introduction to Emergency
Medicine
Slides Courtesy of
American College of Emergency
Physicians
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Everything you want to know about
Emergency Medicine-and dare to ask
John Cunha, DO
Attending Physician
Holy Cross Hospital
Ft. Lauderdale, FL
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Lecture Objectives
Convey an understanding of the field of
Emergency Medicine
Discuss pros and cons of specialty
Describe emergency medicine residency
training
Monetary considerations
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History of Emergency Medicine
Emergency Departments
 Staffed by physicians of various backgrounds
 No specialty training
American College of Emergency Physicians
 Established 1968
ACOEP
 Established in 1975
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Emergency Medicine Residency
First “resident” - 1969
First residencies - 1970
 University of Cincinnati
Emergency Medicine Residents’ Association 1974
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Emergency Medicine Residency
Emergency Medicine Residencies
 1983 - 66 programs
 1990 - 84 programs
 2007-36 AOA programs, 138 AMA programs
 Multiple “combined programs”
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Specialty Selection
Top Ten Leading Causes of Death in the U.S.
Heart Disease: 726,974
Cancer: 539,577
Stroke: 159,791
Chronic Obstructive Pulmonary Disease: 109,029
Accidents: 95,644
Pneumonia/Influenza: 86,449
Diabetes: 62,636
Suicide: 30,535
Nephritis, Nephrotic Syndrome, and Nephrosis
25,331
Chronic Liver Disease and Cirrhosis: 25,175
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Exciting Patient Encounters
Motor vehicle versus pedestrian accident
Acute myocardial infarction
24 yo with GSW to chest
66 yo with CPR in progress
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What’s Your Diagnosis ?
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What’s Your Diagnosis ?
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Not So Exciting Patient Encounters
5 yo with Asthma
75 yo with Emphysema
45 yo alcoholic vomiting blood
3 week old with fever of 104
37 week pregnant female with vaginal
bleeding
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Everyday Non-emergent Patient Encounters
25 yo with a rash
Homeless patient with no other physician
Back pain for 3 months
Migraine headache
Ran out of medicines
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Employment Opportunities
Urban, rural, or suburban hospitals
Teaching or community hospitals

Trauma or not-trauma
Traveling (Locum tenens) physicians
International opportunities
Third world opportunities
Cruise ship
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Appeal of Emergency Medicine
Make an immediate difference
Life threatening injuries and illnesses
Undifferentiated patient population
Challenge of “anything” coming in
Emergency / invasive procedures
Safety net of healthcare
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Appeal of Emergency Medicine
Team approach
Patient advocacy
Open job market
Academic opportunities
Shift work / set hours
Evolving specialty
15
Downside to Emergency Medicine
Interaction with difficult, intoxicated, or violent
patients
Finding follow-up or care for uninsured
Work in a “fishbowl” without 20/20 hindsight
Working as a patient advocate
Contract management groups
Malpractice targets
16
The Lifestyle:
Two Sides of A Coin
Well defined shifts
Usually not on call
Part time employment possible
Evenings and nights
Weekends
Holidays
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Subspecialties in Emergency
Medicine
Pediatric Emergency Medicine
Toxicology
Emergency Medical Services
Sports Medicine
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Areas of Expertise
Toxicology
Emergency medical services
Mass gatherings
Disaster management
Wilderness medicine
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Upcoming Areas of
Emergency Medicine
Observation units
ED ultrasound
International emergency medicine
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Research Opportunities
Broad range of subjects
Limited amount of work published in our
relatively new field
Limited number of research mentors
Limited number of clinical trials
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Number of EM Physicians
4,945 Emergency Departments
Need 32,000 - 37,000 ED physicians to staff
In 2000, 20,164 ACEP members
In 2000, 16,149 EM Board certified physicians
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Emergency Medicine Organizations
American College of Emergency Physicians
American College of Osteopathic Emergency
Medicine
Society for Academic Emergency Medicine
American Academy of Emergency Medicine
Emergency Medicine Residents’ Association
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Where to find more information
www.acoep.org
www.acep.org
www.emra.org
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Emergency Medicine Journals
Annals of Emergency Medicine
Academic Emergency Medicine
Journal of Emergency Medicine
American Journal of Emergency Medicine
Pediatric Emergency Care
Several other Monthly Journals
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EM Interest Groups
Student run organization
“Shadow Shifts”
Journal club
Suture clinic
Radiology lab
EKG clinic
Lectures on EM topics
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What to do to get in to Emergency
Medicine for First and Second Year
Students
Observe in ED
Summer research projects with EM staff
EM interest group affiliation
Be open to any medical specialty
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Emergency Medicine
Third Year Students
See patients in ED on various rotations
Obtain EM physician as mentor
Start selecting fourth year rotations
Try to rotate where you want to be

Even for your “other rotations”
Do a Radiology rotation in one of your earliest
electives
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Emergency Medicine
Fourth Year Students
Mandatory/Elective EM rotation
Rotate where you want to be

Make sure they know why you are there
Consider extramural rotations


Community experience
Opportunity at a residency program
SAEM maintains list of extramural EM rotations
Letters of recommendation
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Combined EM Residency Programs
Emergency Medicine / Pediatrics
Emergency Medicine / Internal Medicine
Emergency Medicine / Internal Medicine /
Critical Care
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MONEY $$$$$
Emergency medicine is very variable

Just about the middle of the physician pay scale
“Academic” situations are less lucrative
“Private groups” are most lucrative
$150,000-400000 is the norm

Also varies on how much you work
“Contract groups” can be very tricky
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How you get compensated
Straight Hourly Rate---$90-150/hour
 Rural (slow) ED=less money
RVU—relative value units (fee for service)
 You see a patient you get paid
 Points based on Medicare tables for how valuable
an intervention you have made
Combination Hourly and RVU
 becoming the most common in private groups
Unique “employee” set –up vs. being self-employed
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Choosing A Specialty
Fit your personality
Decide between general or specialized field
Look at all areas of interest
Ignore gossip and commentary from outside the
specialty you are investigating
Commit to specialty you choose
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American College of
Emergency Physicians
Member Services Department
PO Box 619911
Dallas, TX
75261-9911
1-800-798-1822 Touch 5
www.acep.org
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Emergency Medicine
Residents’ Association
1125 Executive Circle
Irving, TX 75038-2522
1-972-550-0920
www.emra.org
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ACOEP
142 East Ontario Street
Suite 1250
Chicago, Illinois 60611
phone 312.587.3709
800.521.3709
fax 312.587.9951
www.acoep.org
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