| It seems that there are so many emergency | | | | natural disaster, pandemic or terrorist attack. |
| medicine job opportunities, yet so few long-term | | | | Emergency physician are finding it increasingly |
| stable emergency physicians in jobs. Much of this | | | | difficult to obtain much needed on call assistance |
| has to do with the ever-changing practice | | | | for patients needing hospitalization. This is largely |
| environment and at times tenuous relationship | | | | because of uncompensated or undercompensated |
| with the hospital, consultant medical staff, and | | | | services provided by on call specialist, coupled with |
| regulatory bodies. Resultantly, stability even for | | | | rising unresolved medical liability and regulation. |
| the seemingly most sought after emergency | | | | Although once attractive for new graduates, |
| medicine jobs is never assured or guaranteed. In | | | | most new physicians now prefer the security |
| this article, the author explores common practice | | | | afforded by larger well-established groups to the |
| challenges for emergency physician jobs in today's | | | | financial vagaries and lifestyle restrictions of solo |
| healthcare environment. | | | | practice. In so doing, taking ED call becomes more |
| Today, emergency physicians find themselves | | | | of an unwanted burden than an opportunity. |
| working in a crisis environment. This is largely a | | | | The burden is worsened when other factors not |
| result of our Nation's emergency departments | | | | previously mentioned are considered. For example, |
| (EDs) are the only sector of the healthcare | | | | the ever-present medical malpractice threat looms |
| system where there is a federal statue | | | | over emergency medicine. Nowhere else in |
| mandating that care is provided to all patient | | | | medicine can the actions of one specialist always |
| regardless of their ability to pay. Imagine if you | | | | be criticized by what is viewed by the lay public |
| will, a law requiring all of those fast quick lube | | | | as a true specialist in anther specialty. Despite |
| shops to take all motorists, regardless of their | | | | being the best person to manage for example an |
| ability to pay! Between the years of 1994 and | | | | emergency airway, the ED physician will always |
| 2004, ED visits increased from 93.4 million to 110.2 | | | | be subject to the 'definitive' opinion from the true |
| million-an 18 percent increase. Meanwhile, there | | | | expert - the anesthesiologist; as well as the |
| was a significant decline in the numbers of | | | | cardiologist, gastroenterologist, neurologist, etc. |
| hospitals, hospital beds, and emergency | | | | Likewise, the pressure of benchmark |
| departments. The resultant overcrowding long | | | | performance, throughput, volume and acuity of |
| waits, coupled with an under supply of ancillary | | | | patients seen per hour, patient satisfaction, patient |
| support, makes for a crisis work environment. | | | | complaints and admission rates all weight into the |
| Emergency physicians will also find that the rest | | | | equation. The emergency physician also must |
| of medical community inadvertently exacerbates | | | | balance not only the patient as the 'customer' but |
| the existing crisis. The perceived need for | | | | the medical staff, hospital administration, and to |
| hospitals to funnel as many patients as possible | | | | some extent the nursing staff as well. Whereas in |
| through their EDs cripples many tenuous EDs both | | | | other aspects of medicine where the nurse works |
| financially and medically. Primary care delivered in | | | | subordinate to the physician; often in the ED, due |
| the ED is more costly than providing the same | | | | to supply and demand, nurses are having an |
| care in a physician's office, and primary medical | | | | increasingly louder voice in influencing the practice |
| care received through the ED is of poorer quality. | | | | and judgment of physicians in the ED (which may |
| Emergency Physicians have extensive training in | | | | in fact be a good thing for many department and |
| medical and surgical emergency management and | | | | physicians). Nonetheless, this too affects the |
| treatment, however, primary care is best | | | | emergency physician job. |
| reserved for Family Medicine, Internal Medicine, | | | | In general, today's emergency physician is faced |
| and Pediatrics. According to the National Hospital | | | | with numerous challenges and stressors making |
| Ambulatory Medical Care Survey , 47% of | | | | for crisis in the workplace. This crisis directly |
| emergency department visits in 2004 were | | | | affects the likelihood of emergency physicians |
| classified as either emergent (12.9 percent) or | | | | finding lasting stability, in a given practice location in |
| urgent (37.8 percent). The delivery of primary | | | | most cities in the US. Federal support and |
| care in the ED for non-emergent patient care | | | | intervention is needed to release the mounting |
| contributes to ED overcrowding, patient boarding, | | | | pressure that currently worsening. The Institute |
| ambulance diversion, and delayed ambulance | | | | of Medicine, American College of Emergency |
| response times on a daily basis. Resultantly, this | | | | Physicians, and similar institutions are taking great |
| severely limits the system's ability to prepare for | | | | strides in leading change - none of which can |
| and respond to a catastrophic medical disaster, | | | | come all too soon. |