2. Epidemiology/Intro
• 1961 – Alexandria Plan
– 1st ER to have fully staff physician
• 1968 – First national EM meeting
– 32 physician from 18 states
• 1971 – 1st EM training program formed
– Univ of Southern California
– Univ of Louisville
• 1979 – EM became nationally recognized
medical specialty
• 1988 – Last year for “grandfather clause”
3. Epidemiology/Intro
• Currently, the demand for board certified
EP is ≥ 20,0000
–Probably will not be achieved till next
century
–Rural >>> Urban/Suburban
4. Factors That the
Demand for Emergency
Physicians
1) Aging of US population
2) General in US population
3) Greater demand of the public for ambulatory care
services, but insufficient non-ED alternatives
4) Demonstration that improved clinical outcomes
are assoc w/ emergency medicine trained EPs
5) Expansion of out-of-care hospital services/systems
6) Employment of US trained EPs in emergency
health care facilities outside the US
5. Factors That Demand
for Emergency Physicians
1) Closure of hospital EDs
2) Use of “physician extenders” in place of EPs
3) Refusal of payers to fund nonclinical duties by
EPs
4) Transfer of ambulatory care cases currently
managed by EpPs to primary care practitioners
outside the ED
9. Why do they leave the
Field… (1)
• AMA quotes the attrition rate for most
medical specialty is about 2-3%
– For EM: 1.5 to >12%
– Anwar, RAH (1983) reported in his study:
• 5% attrition rate 2 years after EM residency
training
10. Why do they leave the
Field… (2)
• Physicians who left the field
– Long and irregular work schedule
– Financial stability
– Academic vs on your own
– Single vs married
– Board certification
–STRESS
16. Length of Shifts
“Length of the shift should depend on the
physical and mental load of the task”
- Kanauth and Rutenfranz. J Human Ergol 1982 (11)
17. What Do We Prefer???
8 hours vs 12 hours
0%
10%
20%
30%
40%
50%
60%
8 hrs 12 hrs Other
52%
20%
28%
Preferred Shift
18. Length of Shifts:
8 hours vs 12 hours
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
8 hrs 12 hrs 8 & 12 hrs Other 8, 12, and
Other
11.30%
32%
17.70%
26.10%
12.80%
% of shifts worked
% worked
19. Length of Shifts (4):
8 hours vs 12 hours
• Advantages of 12 hrs
– Fewer shift changes
• Fewer transfer of pt care
– Longer time period for
patient care
– Less time working after
shift change
– Less commuting time
– 1/3 more days
completely off
• Advantages of 8 hrs
– More rest
– alertness in the last 2-
4 hrs
– Ability to participate in
personal activities on
workdays
– Ability to apply
circadian principles in
rotating shifts
21. OPTION A: I WANT TO DO ONLY ER
• ACADEMIC
– Love for teaching
– Interaction with
residents/medical
students
– “Cutting edge” practice
– Administrative work
– Research funds
– See Constantly
expanding knowledge
• COMMUNITY
– Higher pay
– More hands on
procedures
– Less non-clinical hours
22. OPTION B: I WANT TO DO A FELLOWSHIP
• BOARD CERTIFICATION
– EMS *
– HOSPICE/PALLIATIVE CARE
– MEDICAL TOXICOLOGY
– PEDIATRIC EM
– SPORTS MEDICINE
– INTERNAL/CRITICAL CARE*
– UNDERSEA/HYPERBARIC
MEDICINE
• CERTIFICATION (NO BOARDS)
– Administration
– Cardiology
– Education
– EMS/Pre-hospital Medicine
– Environmental Medicine
– Disaster Medicine
– Geriatric
– International EM
– Legal
– Medical Informatics
– Research
– Simulation Lab
– Trauma/Critical Care
– Transport Medicine
– Ultrasound
– Wilderness Medicine
– Women’s Health
23. OPTION C: ANY OTHER OPTION
• Go abroad
– Work at any clinic/urgent care cites
• Be a medical ambassador
– Travel to different regions providing care
• Disaster zones
• Under-priveledged areas
• Involve yourself in politics
25. ABEM BOARD CERTIFICATION (1)
INITIAL CERTIFICATION APPLICATION
Application fee if
submitted online
April 15 - July
1, 2013
Application fee if
submitted online
July 2 - August 2,
2013
Application fee if
submitted online
August 3 -
October 1, 2013
Initial
Certification
Application
$420* $575*
(includes late fee)
$1,295*
(includes late fee)
26. ABEM BOARD CERTIFICATION (2)
QUALIFYING EXAMINATION
Examination Name Register and pay online
May 1 - November 1, 2013
Register and pay online
November 2 - 7, 2013
Qualifying Examination
Monday - Sunday,
November 11 - 17, 2013
$960* $1,965*
(includes late fee)
27. STATE LICENSING AND FEE
• Illinois License processing fee: $600.00
– California: $1298
– Texas: $1002
– Florida: $1227
– Indiana: $250
– Michigan: $150 ($230 w/ Controlled Substance)
• Illinois State Physician-controlled Substance License
$5.00 and up to 8 weeks
• DEA application 6 weeks and $551.00
• Apply for NPI number (on line, a few minutes, free)
30. FEDERATION CREDENTIALS
VERIFICATION SERVICES (FCVS)
• Permanent repository of primary-source
verified credentials for physicians
– Lightens the workload of credentialing staff
– Reduces duplication of effort from physician
– Reduces time period to get a license
• Good: those who wish to work in multiple
states
• Bad: Another expense
32. WHAT DO YOUR FELLOW PEERS/
COLLEAGUES HAVE TO SAY?
33. Advice From Your Fellow Colleagues at
ACH (1)
• Get the nurses on your side (D. Girzadas)
– “it’s like starting residency all over again…”
• Show up early or on time (H. Zerth)
– “or colleagues will resent you forever”
• Things move faster than ACH, have a plan
before leaving the patient room (H. Zerth)
– “adding on tests after tests will delay disposition
for 2-3 hrs and are generally frowned upon”
34. Advice From Your Fellow Colleagues at
ACH (2)
• Don’t be afraid to ask your senior co-attending
a question (D. Strasburger)
– “asking for a second opinion is not forbidden”
• It’s not as hard to admit someone (H. Zerth)
– “don’t fight tooth and nails, if you aren’t
comfortable discharging someone then admit”
• You are going to be nervous (H. Zerth)
– “just trust your training and you will do fine ”
35. Advice From Your Fellow Colleagues at
ACH (3)
• Ask for an orientation of your ED (C Kulstad)
– “never want to be in a situation where you have to
look around for something in a hurry (central
lines, ET tubes, chest tubes, etc)”
• Become a “good citizen” by asking how you
could contribute (M.Felder)
– “allows you to find a nitche, both security and
longevity”
36. Advice From Your Fellow Colleagues at
ACH (4)
• Say thank you a lot, act like you want the
business (S Altman)
– “when you are paid full salary, there is no such thing
as an ‘inappropriate’ ED Visit”
• Be involved early and as much as possible(PJ
Konicki)
– “get to know as many attendings outside the ED”
– “attend social and charitable events run by hospital
and medical staff office”
– “Make ED consultation friendly ”
37. Advice From Your Fellow Colleagues at
ACH (5)
• Walk in the door calling your fellow attending by
their first name (S Altman)
– “if you act deferential, you will be treated as a
resident”
• Try to accept all requests for shift trades when
possible, even if they don’t seem fair (S Altman)
– “you will become known as a team player”
– “just keep track of the shifts, beware of anyone who
tries to take advantage of you”
38. Advice From Your Fellow Colleagues at
ACH (6)
- Shadow Shifts -
• Do a shadow shift in a place you are not familiar (A.
Kiernicki-Sklar)
– “important to know how certain processes work before
you start (e.g. transfer, admission, running codes, etc)”
– “allows you to be familiar with the kinds of equipment
they have available”
• Need to know the competency of the staff around
you (A. Kiernicki-Sklar)
– “ancillary staff may not know the medications you are
familiar with”
– “will they be able to recognize a sick patient?”
39. Advice From Your Fellow Colleagues at
ACH (7)
- Watch your words-
• Listen first, talk last (T. Ross)
• Give advice/opinion ONLY when asked (T. Ross)
• Do not get in an argument for any reason – DO NOT
raise your voice (T. Ross)
– “remember, you are under watch at all times”
• Never engage in any talk complaining about one of
your colleagues (T. Ross)
– If someone asks, respond back by saying: “you haven’t noticed
that, but how about them Bears”
40. Advice From Your Fellow Colleagues at
ACH (8)
- Watch your words-
“I think you will find that if you stop complaining you
might not need to do it as much anymore. Once
you start, it is hard to stop. Think of complaining
like cigarettes and stay away... (Oh, how I would
love to have a smoke!!)” (T. Ross)
41. Advice From Your Fellow Colleagues at
ACH (9)
- Financial Help-
• Live like a resident for 2 more years (S Altman)
– “a dollars saved today is worth more than one saved
tomorrow”
– “put off that temptation of buying that Lexus/Porsche”
– “ONLY EXCEPTION IS BUYING A HOUSE”
• Maximize tax deferred opportunities (S. Altman)
– “money saved in this account is untouchable in case of
divorce, law suit, or even criminal activity”
• Look for a good team to manage your
investments/retirements/disability (A Katiyar)
42. Advice From Your Fellow
Colleagues at ACH (10)
- AND AT LAST…-
• Remember this is your last year of training…
– Start forming your “thinking process”
• Ask yourself, “what will I do if I were on my own”?
– Get comfortable with as many procedures
• EJs, central lines, chest tubes, LP, etc…
• What have I not done?
– Challenge yourself everyday with seeing pts
• There is no limit, try to see as many pt as you can…
– Learn how to chart efficiently!!!
• Don’t lose money!
