What Does Academic Emergency Medicine Look Like?

Session 67

Dr. Elaine Reno is an academic Emergency Medicine physician in Denver. Elaine has a fellowship in wilderness medicine, which is really not that big of a practice. So today we focus on academic emergency medicine.

Back in Session 2, we had Dr. Freess talking about community-based emergency medicine. Today Dr. Reno talks about why she chose academic emergency medicine, what her lifestyle and work-life balance are like, and much more.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[02:10] An Interest in Emergency Medicine

As a medical student, two different specialties appealed to Elaine: Emergency Medicine and OB/GYN. She thinks they’re both pretty similar, being 90% routine and 10% acute crisis. Eventually, she realized she likes the variety in emergency medicine. She also didn’t like the operating room very much.

If you think emergency medicine is all about gunshot wounds and adrenaline rush, Elaine says that most chest pains are not heart attacks; in most car accidents, the people are fine; and most weakness or tingling sensations are not strokes.

The life of an emergency medicine physician is much more routine than what most people think.Click To Tweet

[04:05] Traits that Make a Good Emergency Medicine Doctor

Elaine explains that in emergency medicine, you’re always going to need help—you’re always going to need to talk to your specialty consultants. So you have to be a good communicator. You have to be able to work with your specialty consultants.

Emergency medicine is like a team sport. You have to be able to work in a team with other physicians, nurses, PAs, and others. So you need to be a good collaborator and communicator.

More than any other medical specialty, emergency medicine is like an extreme team sport. You have to be able to work in a team.Click To Tweet

[06:00] Types of Patients and Typical Week in Emergency Medicine

Emergency medicine doctors see anything and everything on a day-to-day basis. The common things they see are flu, respiratory illness, chest pain, abdominal pain, and headaches. People come in with symptoms rather than diseases, and it’s your job to figure out what’s going on and what you need to do to manage it.

The bread and butter cases in emergency medicine are flu, respiratory illness, chest pain, abdominal pain, and headaches.Click To Tweet

A typical week in emergency medicine varies a lot. Elaine likes the variety of it even if other people hate that. Every week, her schedule is different and she likes it a lot.

As an ER doctor, she mans the doors of the emergency room, so she deals with everything that rolls in during her shift. They handle an extreme variety of cases every day, from chest pains coming from heart attacks and strokes to trauma patients, to cancer patients with infections or miscarriages or broken bones.

[08:05] Academic Emergency Medicine vs. Community-Based or Private Practice

What Elaine likes about academic emergency medicine is the teaching part of it. She likes working with the residents and teaching classes for undergrad students. Elaine also describes the residents as very smart. You have to stay on your toes to keep up with the residents. Nevertheless, she likes the learning and education that come with an academic setting.

'I just like the academic flavor—there's ongoing learning every single day. I feel like it challenges me every day to learn more and to be a better doctor.'Click To Tweet

[09:20] Is Emergency Medicine a Good Fit for You?

Emergency medicine physicians do a lot of procedures. They’re not surgeons, but more like intensivists in the level of procedures they do. Gastroenterologists and cardiologists do more procedures than them. Family medicine doctors do less.

EM physicians place central lines and arterial lines. Occasionally, they do intubation. If you hate procedures, emergency medicine is probably not the specialty for you.

If you really like the flavor of emergency medicine but don't like doing so many procedures, you could do something like urgent care.Click To Tweet

[10:20] What Is the Lifestyle Like for an Emergency Medicine Doctor?

Although they sometimes cover for doctors who call in sick, EM doctors don’t really have to take call. No one calls them about patient care, and Elaine likes that aspect of the specialty a lot.

When it comes to hours and shifts, Elaine explains it’s different for every doctor in every clinical practice. In an academic setting, you might also be doing things like research and education, so you do fewer clinical shifts. In emergency medicine, you don’t have a long-term patient population like a primary care doctor has, so you’re able to do this.

Family Life as an Emergency Medicine Physician

Elaine just had a baby. She had to stop working for a little bit after having a difficult pregnancy. But she’s felt that she has been able to spend adequate time with her baby.

I do feel like emergency medicine is actually very conducive towards a family life. But you still have to be creative about how you make it workClick To Tweet

If you feel like if you’re working too much and that you’re not having enough time with family, then you can always just step down and not work full time. That’s an option in emergency medicine. In terms of making quality time, it’s about making that quality time.

Of course, someone has to be in the ER on Christmas, Thanksgiving, and New Years. So this will be a part of her job for the rest of her life. And she’s okay with it. But when she’s with her family, they turn off their phones and prioritize being together.

If you feel like you're working too much and you're not having enough time with family, then you can always just step down and not work full time. That's an option in emergency medicine.Click To Tweet

[14:14] The Residency Path to Become an Academic EM Doctor

Emergency medicine is a three-year or four-year residency depending on where you go. Most of them are becoming four-year residencies. Most EM physicians going into academics go through a four-year residency.

During your first year, you rotate through different specialties. You learn a little bit of everything. Then you spend more and more time in the emergency room as you progress through residency training.

Competitiveness of Emergency Medicine Residency Programs

EM residency programs are getting more and more competitive due mainly to it being a conducive specialty for having a good lifestyle and having other interests. It’s getting more and more competitive every year.

EM residency programs are getting more and more competitive due mainly to it being a conducive specialty for having a good lifestyle and having other interests.Click To Tweet

Having been involved in the admissions side of things for an emergency medicine residency, Elaine’s advice to be competitive in EM is the following: Get good grades and excel in your clerkships. Do well not just in one specialty you want to go into but in all of your clerkships. They also look at your extracurriculars, research, letters of recommendation, etc. So be a well-rounded candidate.

[16:18] Bias Against DOs in Emergency Medicine?

The DO and MD match are integrating in 2020. Elaine thinks this is the right way moving forward. She works with DOs, and she thinks the bias against them is slowly fading away. There will still be some inherent bias, but she really doesn’t think it’s a big thing based on what she’s seen.

Subspecialties in Emergency Medicine

After residency training, there are also fellowships in emergency medicine like toxicology, global health, admin, education, and ultrasound. Elaine subspecialized in wilderness medicine with a little bit of global health.

A lot of the EM doctors who do fellowships end up in academics. So if you do an education fellowship, you end up doing education work. For toxicology, they end up being a consult service.

With her diploma in tropical medicine and hygiene, Elaine works part-time at a travel clinic and does pre-travel advising coordination. She basically works with a pediatric infectious disease doctor to provide care for the whole family.

[20:00] Working with Primary Care and Other Specialties

If you’re a primary care physician and you want to send a patient to the emergency room, communication is key. Coordination is very important since the EM physicians won’t get to manage the patient long term.

A lot of times in emergency medicine, you get a snapshot of a moment in time. You treat the acute exacerbation of someone's COPD—but it's a primary care doc who helps manage it long term.Click To Tweet

Other specialties that EM physicians work the closest with include trauma, cardiology, and intensive care units. Special opportunities outside of clinical medicine for EM doctors would be in education, full-time research, administrative work, and as EMS directors.

[23:18] What She Wished She Knew About Emergency Medicine

Elaine wishes she knew in advance how much it would affect her sleep to have brutal rotating schedules as an EM physician. She would have still chosen the same specialty, but she could have started taking melatonin earlier.

What she likes the most about being an EM doctor is the variety. And the thing she likes the least is the circadian rhythm disruption.

[24:45] Major Changes in the Future of Emergency Medicine

In the future of emergency medicine, the focus will likely increasingly be on keeping patients out of the hospital. Nowadays, EM physicians train with social workers, physical therapists, mental health counselors, and case managers. They try to figure out what they can do to keep patients at home.

The push to keep patients out of the hospital and away from hospital-borne illnesses and complications is definitely there.Click To Tweet

Another thing Elaine is concerned about for the future is continuity of care after an emergency department visit. This is especially crucial for patients who may be underinsured. In an ideal situation, everyone would have a great primary care doctor that they can trust, and they could call and get access to continued care.

Advice for Those in Premed and Medical School

Ultimately, if Elaine had to do it all over again, she would still choose emergency medicine. Her final words of wisdom for premed students and medical students out there is that medicine is a great profession but it has to be what you want to do. Make sure it’s what you want, and you’re not just doing this due to familial pressure or peer pressure.

At the end of the day, you’re the one doing this, so make sure you’re pursuing something you want to do. If you don’t know or are not ready yet, don’t apply yet. Take the year off. Travel, work. Get more shadowing and clinical experience to determine if this is right for you.

Medicine is not just marathon—it's an ultramarathon. So it doesn't matter if you start med school when you're 22 or 25... make sure it's the right choice first.Click To Tweet

Links and Other Resources

Check out my Premed Playbook series of books (available on Amazon), with installments on the personal statement, the medical school interview, and the MCAT.
Related episode: Important Details About (Almost) Every Medical Specialty.
Related episode: What Is Emergency Medicine?
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