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Introduction to Emergency Medicine

Introduction to Emergency Medicine . Slides Courtesy of American College of Emergency Physicians. Everything you want to know about Emergency Medicine-and dare to ask. John Cunha, DO Attending Physician Holy Cross Hospital Ft. Lauderdale, FL. Lecture Objectives.

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Introduction to Emergency Medicine

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  1. Introduction to Emergency Medicine Slides Courtesy of American College of Emergency Physicians

  2. Everything you want to know about Emergency Medicine-and dare to ask John Cunha, DO Attending Physician Holy Cross Hospital Ft. Lauderdale, FL

  3. Lecture Objectives • Convey an understanding of the field of Emergency Medicine • Discuss pros and cons of specialty • Describe emergency medicine residency training • Monetary considerations

  4. 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

  5. Emergency Medicine Residency • First “resident” - 1969 • First residencies - 1970 • University of Cincinnati • Emergency Medicine Residents’ Association - 1974

  6. Emergency Medicine Residency • Emergency Medicine Residencies • 1983 - 66 programs • 1990 - 84 programs • 2007-36 AOA programs, 138 AMA programs • Multiple “combined programs”

  7. 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

  8. Exciting Patient Encounters • Motor vehicle versus pedestrian accident • Acute myocardial infarction • 24 yo with GSW to chest • 66 yo with CPR in progress

  9. What’s Your Diagnosis ?

  10. What’s Your Diagnosis ?

  11. 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

  12. 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

  13. 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

  14. 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

  15. Appeal of Emergency Medicine • Team approach • Patient advocacy • Open job market • Academic opportunities • Shift work / set hours • Evolving specialty

  16. 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

  17. The Lifestyle:Two Sides of A Coin • Well defined shifts • Usually not on call • Part time employment possible • Evenings and nights • Weekends • Holidays

  18. Subspecialties in Emergency Medicine • Pediatric Emergency Medicine • Toxicology • Emergency Medical Services • Sports Medicine

  19. Areas of Expertise • Toxicology • Emergency medical services • Mass gatherings • Disaster management • Wilderness medicine

  20. Upcoming Areas of Emergency Medicine • Observation units • ED ultrasound • International emergency medicine

  21. 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

  22. 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

  23. 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

  24. Where to find more information • www.acoep.org • www.acep.org • www.emra.org

  25. 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

  26. EM Interest Groups • Student run organization • “Shadow Shifts” • Journal club • Suture clinic • Radiology lab • EKG clinic • Lectures on EM topics

  27. 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

  28. Emergency MedicineThird 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

  29. Emergency MedicineFourth 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

  30. Combined EM Residency Programs • Emergency Medicine / Pediatrics • Emergency Medicine / Internal Medicine • Emergency Medicine / Internal Medicine / Critical Care

  31. 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

  32. 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

  33. 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

  34. American College ofEmergency Physicians Member Services Department PO Box 619911 Dallas, TX 75261-9911 1-800-798-1822 Touch 5 www.acep.org

  35. Emergency MedicineResidents’ Association 1125 Executive Circle Irving, TX 75038-2522 1-972-550-0920 www.emra.org

  36. 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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