The Role Of An Emergency Medicine Doctor
Emergency medicine is a dynamic specialty, offering a large day-to-day variety in medical cases and situations. Emergency medicine doctors treat patients from all age groups and with a large spectrum of physical and mental disorders.
Some examples of conditions treated by EM doctors are loss of consciousness (eg, as a result of an injury, substance abuse, seizure), severe bleeding, brain or other major organ damage due to trauma, mental health problems (eg, self-harm patients), and more.(1)
Emergency medicine is exceptionally challenging as often the doctor will have limited information about a patient upon admission and may have to carry out procedures without patient’s diagnosis or full consent.(2)
A career in emergency medicine will require sound clinical skills, more so than most other clinical specialties. Common interventions will be carried out by the EM doctor to maximise the patient’s chances of survival and best possible recovery.
Examples of these interventions are defibrillation, endotracheal intubation, joint relocation, and tracheostomy.(1) An EM doctor needs a profound understanding of both pre-hospital and in-hospital emergency medical systems to provide the best care possible.
Emergency medicine doctors mostly work in accident and emergency departments (A&E), where they deal predominantly with outpatients.(2) Most of the patients in the A&E are discharged soon after they are treated, but some will be admitted to the hospital and referred to other specialties if necessary.(2)
EM doctors may also work in, for example, inpatient hospital specialties (eg, paediatrics), minor work injuries units, regional trauma networks, at scenes of major accidents, or at major events (sports events, concerts, etc).(2)
Emergency medicine doctors work in large multidisciplinary teams alongside paramedics, nurses, emergency nurse practitioners, hospital security, police officers, and administrative staff.(2) They also associate closely with other specialties such as geriatrics, acute medical care or paediatrics.(2)
Sound and quick decision making, good communication skills, flexibility and adaptability, attention to detail, resilience are only some of the qualities that are looked for in potential emergency medicine doctors. Applicants and trainees should look to work on these and apply them to their everyday life and work.(3)
Much of the workforce in emergency medicine is still male, 70% of the emergency medicine doctors and specialty associate staff being male and only 30% female.(4)
Over time, emergency medicine will be increasingly affected by ageing population with higher rates of obesity and lifestyle-related diseases. This will likely change the ways in which EM doctors’ approach and treat their patients, as cases will become more complex with greater number of comorbidities.(2)
A Typical Day
The working hours in emergency medicine are variable, as the doctors will be working a combination of night shifts, day shifts and on-call shifts.(2) The working time of an EM consultant is divided into Professional Activities (PAs).
Up to 10 PAs are normally pensionable, and each PA within regular working hours is 4 hours long, and a PA outside normal working time is usually 3 hours.(5)
The work of an EM consultant is divided between direct clinical care (DCC), supporting professional activities (SPAs), additional responsibilities and external duties.(5) Direct clinical care consists of emergency duties, diagnostic work, operating sessions, outpatient care and other patient treatment, and administrative and organisational work.(5)
Supporting activities include working in management and educational posts, undertaking research, or training medical students/trainees, and 1-4 PAs a week are dedicated to each of them depending on their difficulty.(5) An EM doctor is required to take a minimum of 2.5PAs dedicated to supporting activities.(5)
On-call time is divided into 2 components - unpredictable emergency work, and on-call supplement. Unpredictable emergency work will often require the consultant to return to site or deal with complex queries and carry out consultations over the phone.(5) The on-call supplement consists of giving advice to those on site over the phone.(5) Emergency medicine consultants’ on-call workload predominantly consists of unpredictable emergency work.
EM doctors on a day shift usually start work at about 8am, check in on patients in the resuscitation unit, treat them and send them to the intensive care unit. This is followed by taking handover from night staff, checking emails and the day rota.(6)
Most of the morning is spent on trauma calls and taking care of the patients in resuscitation, and the afternoon is divided between direct clinical care and supporting or additional activities, e.g. teaching and management.(6) The day shift usually finishes at about 6pm.(6) Depending on the nature of each doctor’s work, they might have other responsibilities after their shift, such as providing medical care at a sports event.
Route To A Career In EM
The entry requirements for the start of emergency medicine training are a completed medical degree (undergraduate or postgraduate), and 2 years of foundation training. A trainee may choose to start emergency medicine training via a few different routes.
One option is through the acute care common stem (ACCS) and complete core training, CT1-CT3, before entering higher specialty training (HST).(7) Entry into HST is also possible via the run through programme, ST1-ST6. It is also possible to carry out the first 3 years in ACCS training in a different acute specialty or in surgery and enter ST3 via a defined route of entry into emergency medicine (DRE-EM). (7)
The entry into ST1/CT1 is by a competitive application, the competitive ratios being 2.14 applicants per post.(7, 8) After ST2/CT2, trainees are required to take the Fellowship of the College of Emergency Medicine (FRCEM) Primary exam to progress into year 3.(7) After ST3/CT3, trainees need to complete the FRCEM Intermediate exam to progress to higher specialty training (HST).(7) Trainees taking the ACCS/surgical training route will enter HST via a competitive application process (competition ratio 1.47 applicants per post) and may need to undertake a Membership of the Royal College of Surgeons exam.
At the end of higher specialty training, the trainees sit the FRCEM final exam.(7, 8) After completing specialty training and passing the required assessments, the trainee will receive Certification of completion of Training (CCT) in emergency medicine, or a dual CCT in EM and internal care medicine.(7, 9)
During their HST, trainees may choose to take interest in either of pre-hospital EM or paediatric EM as a subspecialty and develop this within the HST curriculum, or they can undertake a dual CCT with Intensive Care Medicine, this will however prolong the training period to 8.5 years instead of 6.(9) There are also many opportunities for research, both during training (you may also choose to train part-time) or during consultancy.
Medical students thinking about a career in emergency medicine should try to get experience in EM or another acute specialty, choose a supervised research project related to EM, and get involved with professional bodies such as the GMC, BMA, and RCEM.(9)
Foundation trainees are advised to apply for EM and other related specialties (acute internal or general internal medicine) in their rotations. They should also take part in clinical audit and relate it to EM where possible, complete relevant modules on the RCEM learning site and attend RCEM training or career days. It is always recommended to ask for advice from experienced EM doctors.(9)
Core and specialty trainees should undertake research and try to get published or present their projects in national and international meetings. They should take management and teaching opportunities if possible and stay up to date with the current issues in the specialty.(9)
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Trainee doctors earn a basic salary between £28,243 to £32,691.(10) At the start of specialty training this increases to £38,693 to £49,036, and as a specialty registrar you will be paid a basic salary between £40,037 to £74,661.(10) These values are subject to individual changes for any extra work or responsibilities. Consultants may choose to supplement their salary by working privately.
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Before applying for a career in emergency medicine, the applicants are advised to conduct some research and get to know the specialty. There are many useful resources for this. The Oxford Handbook of Emergency Medicine is a largely recommended book that summarises the specialty and contains advice on EM management.
The Paediatric Observation Priority Score (POPS) app is a useful tool for practising decision making in urgent and emergency care. There are also several podcasts discussing emergency medicine, a useful one being The Resus Room, a podcast-based website that discusses different emergency medicine topics in each podcast episode.
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