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Introduction to Emergency Introduction to Emergency Medicine Medicine

Slides Courtesy ofSlides Courtesy of

American College of Emergency American College of Emergency PhysiciansPhysicians

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Everything you want to know about Everything you want to know about Emergency Medicine-and dare to askEmergency Medicine-and dare to ask

John Cunha, DOJohn Cunha, DO

Attending PhysicianAttending Physician

Holy Cross HospitalHoly Cross Hospital

Ft. Lauderdale, FLFt. Lauderdale, FL

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Lecture ObjectivesLecture Objectives

Convey an understanding of the field of Convey an understanding of the field of Emergency MedicineEmergency Medicine

Discuss pros and cons of specialtyDiscuss pros and cons of specialty

Describe emergency medicine residency Describe emergency medicine residency training training

Monetary considerationsMonetary considerations

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History of Emergency MedicineHistory of Emergency Medicine

Emergency DepartmentsEmergency Departments Staffed by physicians of various backgroundsStaffed by physicians of various backgrounds No specialty trainingNo specialty training

American College of Emergency PhysiciansAmerican College of Emergency Physicians Established 1968Established 1968

ACOEPACOEP Established in 1975Established in 1975

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Emergency Medicine ResidencyEmergency Medicine Residency

First “resident” - 1969First “resident” - 1969

First residencies - 1970First residencies - 1970 University of CincinnatiUniversity of Cincinnati

Emergency Medicine Residents’ Association - Emergency Medicine Residents’ Association - 19741974

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Emergency Medicine ResidencyEmergency Medicine Residency

Emergency Medicine ResidenciesEmergency Medicine Residencies 1983 - 66 programs1983 - 66 programs 1990 - 84 programs1990 - 84 programs 2007-36 AOA programs, 138 AMA programs2007-36 AOA programs, 138 AMA programs Multiple “combined programs”Multiple “combined programs”

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Specialty Selection Specialty Selection Top Ten Leading Causes of Death in the U.S.Top Ten Leading Causes of Death in the U.S.

Heart Disease: Heart Disease: 726,974726,974Cancer: Cancer: 539,577539,577Stroke: Stroke: 159,791159,791Chronic Obstructive Pulmonary Disease: Chronic Obstructive Pulmonary Disease: 109,029109,029Accidents: Accidents: 95,64495,644Pneumonia/Influenza: Pneumonia/Influenza: 86,44986,449Diabetes: Diabetes: 62,63662,636Suicide: Suicide: 30,53530,535Nephritis, Nephrotic Syndrome, and Nephrosis Nephritis, Nephrotic Syndrome, and Nephrosis 25,33125,331Chronic Liver Disease and Cirrhosis: Chronic Liver Disease and Cirrhosis: 25,17525,175

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Exciting Patient EncountersExciting Patient Encounters

Motor vehicle versus pedestrian accidentMotor vehicle versus pedestrian accident

Acute myocardial infarctionAcute myocardial infarction

24 yo with GSW to chest24 yo with GSW to chest

66 yo with CPR in progress66 yo with CPR in progress

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What’s Your Diagnosis ?What’s Your Diagnosis ?

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What’s Your Diagnosis ?What’s Your Diagnosis ?

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Not So Exciting Patient EncountersNot So Exciting Patient Encounters

5 yo with Asthma5 yo with Asthma

75 yo with Emphysema75 yo with Emphysema

45 yo alcoholic vomiting blood45 yo alcoholic vomiting blood

3 week old with fever of 1043 week old with fever of 104

37 week pregnant female with vaginal 37 week pregnant female with vaginal bleedingbleeding

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Everyday Non-emergent Patient EncountersEveryday Non-emergent Patient Encounters

25 yo with a rash 25 yo with a rash

Homeless patient with no other physicianHomeless patient with no other physician

Back pain for 3 monthsBack pain for 3 months

Migraine headacheMigraine headache

Ran out of medicinesRan out of medicines

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Employment OpportunitiesEmployment Opportunities

Urban, rural, or suburban hospitalsUrban, rural, or suburban hospitals

Teaching or community hospitalsTeaching or community hospitals Trauma or not-traumaTrauma or not-trauma

Traveling (Locum tenens) physiciansTraveling (Locum tenens) physicians

International opportunitiesInternational opportunities

Third world opportunitiesThird world opportunities

Cruise shipCruise ship

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Appeal of Emergency MedicineAppeal of Emergency Medicine

Make an immediate differenceMake an immediate difference

Life threatening injuries and illnessesLife threatening injuries and illnesses

Undifferentiated patient populationUndifferentiated patient population

Challenge of “anything” coming inChallenge of “anything” coming in

Emergency / invasive proceduresEmergency / invasive procedures

Safety net of healthcareSafety net of healthcare

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Appeal of Emergency MedicineAppeal of Emergency Medicine

Team approachTeam approach

Patient advocacyPatient advocacy

Open job marketOpen job market

Academic opportunities Academic opportunities

Shift work / set hoursShift work / set hours

Evolving specialtyEvolving specialty

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Downside to Emergency MedicineDownside to Emergency Medicine

Interaction with difficult, intoxicated, or violent Interaction with difficult, intoxicated, or violent patientspatients

Finding follow-up or care for uninsuredFinding follow-up or care for uninsured

Work in a “fishbowl” without 20/20 hindsight Work in a “fishbowl” without 20/20 hindsight

Working as a patient advocateWorking as a patient advocate

Contract management groupsContract management groups

Malpractice targetsMalpractice targets

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The Lifestyle:The Lifestyle:Two Sides of A CoinTwo Sides of A Coin

Well defined shiftsWell defined shifts

Usually not on callUsually not on call

Part time employment possiblePart time employment possible

Evenings and nightsEvenings and nights

WeekendsWeekends

Holidays Holidays

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Subspecialties in Emergency Subspecialties in Emergency MedicineMedicine

Pediatric Emergency MedicinePediatric Emergency Medicine

ToxicologyToxicology

Emergency Medical ServicesEmergency Medical Services

Sports MedicineSports Medicine

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Areas of ExpertiseAreas of Expertise

ToxicologyToxicology

Emergency medical servicesEmergency medical services

Mass gatheringsMass gatherings

Disaster management Disaster management

Wilderness medicineWilderness medicine

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Upcoming Areas of Upcoming Areas of Emergency MedicineEmergency Medicine

Observation unitsObservation units

ED ultrasoundED ultrasound

International emergency medicineInternational emergency medicine

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Research OpportunitiesResearch Opportunities

Broad range of subjectsBroad range of subjects

Limited amount of work published in our Limited amount of work published in our relatively new fieldrelatively new field

Limited number of research mentorsLimited number of research mentors

Limited number of clinical trialsLimited number of clinical trials

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Number of EM PhysiciansNumber of EM Physicians

4,945 Emergency Departments4,945 Emergency Departments

Need 32,000 - 37,000 ED physicians to staffNeed 32,000 - 37,000 ED physicians to staff

In 2000, 20,164 ACEP membersIn 2000, 20,164 ACEP members

In 2000, 16,149 EM Board certified physicians In 2000, 16,149 EM Board certified physicians

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Emergency Medicine OrganizationsEmergency Medicine Organizations

American College of Emergency PhysiciansAmerican College of Emergency Physicians

American College of Osteopathic Emergency American College of Osteopathic Emergency MedicineMedicine

Society for Academic Emergency MedicineSociety for Academic Emergency Medicine

American Academy of Emergency MedicineAmerican Academy of Emergency Medicine

Emergency Medicine Residents’ AssociationEmergency Medicine Residents’ Association

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Where to find more informationWhere to find more information

www.acoep.orgwww.acoep.org

www.acep.orgwww.acep.org

www.emra.orgwww.emra.org

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Emergency Medicine JournalsEmergency Medicine Journals

Annals of Emergency MedicineAnnals of Emergency Medicine

Academic Emergency MedicineAcademic Emergency Medicine

Journal of Emergency MedicineJournal of Emergency Medicine

American Journal of Emergency MedicineAmerican Journal of Emergency Medicine

Pediatric Emergency CarePediatric Emergency Care

Several other Monthly JournalsSeveral other Monthly Journals

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EM Interest GroupsEM Interest Groups

Student run organizationStudent run organization

““Shadow Shifts”Shadow Shifts”

Journal clubJournal club

Suture clinicSuture clinic

Radiology labRadiology lab

EKG clinicEKG clinic

Lectures on EM topicsLectures on EM topics

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What to do to get in to Emergency What to do to get in to Emergency Medicine for First and Second Year Medicine for First and Second Year

StudentsStudents

Observe in EDObserve in ED

Summer research projects with EM staffSummer research projects with EM staff

EM interest group affiliationEM interest group affiliation

Be open to any medical specialtyBe open to any medical specialty

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Emergency MedicineEmergency MedicineThird Year StudentsThird Year Students

See patients in ED on various rotationsSee patients in ED on various rotations

Obtain EM physician as mentorObtain EM physician as mentor

Start selecting fourth year rotationsStart selecting fourth year rotations

Try to rotate where you want to beTry to rotate where you want to be Even for your “other rotations”Even for your “other rotations”

Do a Radiology rotation in one of your earliest Do a Radiology rotation in one of your earliest electiveselectives

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Emergency MedicineEmergency MedicineFourth Year StudentsFourth Year Students

Mandatory/Elective EM rotationMandatory/Elective EM rotation

Rotate where you want to beRotate where you want to be Make sure they know why you are thereMake sure they know why you are there

Consider extramural rotations Consider extramural rotations Community experienceCommunity experience Opportunity at a residency program Opportunity at a residency program

SAEM maintains list of extramural EM rotationsSAEM maintains list of extramural EM rotations

Letters of recommendationLetters of recommendation

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Combined EM Residency ProgramsCombined EM Residency Programs

Emergency Medicine / PediatricsEmergency Medicine / Pediatrics

Emergency Medicine / Internal MedicineEmergency Medicine / Internal Medicine

Emergency Medicine / Internal Medicine / Emergency Medicine / Internal Medicine / Critical CareCritical Care

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MONEY $$$$$MONEY $$$$$

Emergency medicine is very variableEmergency medicine is very variable Just about the middle of the physician pay scaleJust about the middle of the physician pay scale

““Academic” situations are less lucrativeAcademic” situations are less lucrative

““Private groups” are most lucrativePrivate groups” are most lucrative

$150,000-400000 is the norm$150,000-400000 is the norm Also varies on how much you workAlso varies on how much you work

““Contract groups” can be very trickyContract groups” can be very tricky

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How you get compensatedHow you get compensated

Straight Hourly Rate---$90-150/hourStraight Hourly Rate---$90-150/hour Rural (slow) ED=less money Rural (slow) ED=less money RVU—relative value units (fee for service)RVU—relative value units (fee for service) You see a patient you get paidYou see a patient you get paid Points based on Medicare tables for how valuable Points based on Medicare tables for how valuable

an intervention you have madean intervention you have madeCombination Hourly and RVUCombination Hourly and RVU becoming the most common in private groupsbecoming the most common in private groupsUnique “employee” set –up vs. being self-employedUnique “employee” set –up vs. being self-employed

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Choosing A SpecialtyChoosing A Specialty

Fit your personalityFit your personality

Decide between general or specialized fieldDecide between general or specialized field

Look at all areas of interestLook at all areas of interest

Ignore gossip and commentary from outside the Ignore gossip and commentary from outside the specialty you are investigatingspecialty you are investigating

Commit to specialty you chooseCommit to specialty you choose

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American College ofAmerican College ofEmergency PhysiciansEmergency Physicians

Member Services DepartmentMember Services Department

PO Box 619911PO Box 619911

Dallas, TX Dallas, TX 75261-991175261-9911

1-800-798-1822 Touch 51-800-798-1822 Touch 5

www.acep.orgwww.acep.org

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Emergency MedicineEmergency MedicineResidents’ AssociationResidents’ Association

1125 Executive Circle1125 Executive Circle

Irving, TX 75038-2522Irving, TX 75038-2522

1-972-550-09201-972-550-0920

www.emra.orgwww.emra.org

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ACOEPACOEP

142 East Ontario Street142 East Ontario StreetSuite 1250Suite 1250Chicago, Illinois 60611Chicago, Illinois 60611

phone 312.587.3709 phone 312.587.3709 800.521.3709   800.521.3709   fax 312.587.9951fax 312.587.9951www.acoep.orgwww.acoep.org