Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute interventions to stabilize the patient. Emergency medicine physicians practice in hospital emergency departments, in pre-hospital settings via emergency medical services, other locations where initial medical treatment of illness takes place, and recently the intensive-care unit. Just as clinicians operate by immediacy rules under large emergency systems, emergency practitioners aim to diagnose emergent conditions and stabilize the patient for definitive care.
Physicians specializing in emergency medicine in the US and Canada can enter fellowships to receive credentials in subspecialties. These are palliative medicine, medical toxicology, wilderness medicine, pediatric emergency medicine, sports medicine, and undersea and hyperbaric medicine.
Emergency medicine has evolved to treat conditions that pose a threat to life, limb, or have a significant risk of morbidity. In the words of the International Federation for Emergency Medicine:
“Emergency medicine is a medical specialty—a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”
Emergency Medicine encompasses a large amount of general medicine and surgery including the surgical sub-specialties. Emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition—either admitting them to the hospital or releasing them after treatment as necessary. The emergency physician requires a broad field of knowledge and advanced procedural skills often including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management. Emergency physicians must have the skills of many specialists—the ability to resuscitate a patient (Critical Care Medicine), manage a difficult airway (Anesthesia), suture a complex laceration (Plastic Surgery), reduce (set) a fractured bone or dislocated joint (Orthopedic surgery), treat a heart attack (Cardiology), work-up a pregnant patient with vaginal bleeding (Obstetrics and Gynecology), stop a bad nosebleed (ENT), place a chest tube (Cardiothoracic Surgery), and to conduct and interpret ultrasounds (Radiology).
WorkThe employment arrangement of emergency physician practices are either private (a democratic group of EPs staff an ED under contract), institutional (EPs with an independent contractor relationship with the hospital), corporate (EPs with an independent contractor relationship with a third party staffing company that services multiple emergency departments) or governmental (employed by the US armed forces, the US public health service, the Veteran’s Administration or other government agency).
Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the 24/7 nature of the emergency department. In the United States, emergency medicine practitioners are expected to be competent in treating, diagnosing and managing a wide array of illnesses and conditions, both chronic and acute. Contrary to popular belief, emergency physicians do not treat a disproportionate number of, nor do they provide primary care to, the uninsured. In Massachusetts, when health insurance became mandatory, emergency department usage actually rose. Overall, more than half of emergency physicians report high levels of career satisfaction. Although career satisfaction has remained high among emergency physicians, concern about burnout is substantial.
In the United Kingdom all Consultants in Emergency Medicine work in the NHS. There is little scope for private emergency practice.
In Turkey, EM specialist may choose to work in private (corporate hospitals), governmental (all the hospitals under Ministry of Health) or institutional (University Hospitals) EDs. However most of the EPs work in governmental or university hospitals.
According to the American College of Emergency Physicians, the US will likely face a shortage of physicians in the near future, leading to increased employment opportunities.