Considering a career in EM?
Emergency Medicine has developed into an exciting and rewarding career, which attracts individuals who thrive on challenge, uncertainty and variety. A career in EM will never be dull and offers chances to develop your own interests and areas of expertise within a broad range of patient presentations.
A College guide to a career in Emergency Medicine is available to download here. If you have any questions about careers that are not answered here please email Marlies.Kunnen@collemergencymed.ac.uk
Real life stories
current Emergency Medicine doctors were asked the following questions about their experiences, click on the questions below to read their answers
I liked the prospect of working with lots of people in a large team, and meeting lots of interesting patients. There is constant variety and challenge: exposure to a great deal of "real life". It is very intellectually stimulating: high decision density with limited information. There are also strong opportunities for innovation and service improvement.
Jonathan Benger
I have the attention span of a gerbil - so the continuous challenge of new patients, with unknown conditions makes the specialty perfect for me. I like the unpredictable nature of the work and I like the characters that you get in the ED - both the patients, and the staff. Team working and collaboration with nurses is probably a hallmark of the specialty and I enjoy the fact that ED nurses are mostly feisty and self opinionated - which makes working much more fun!
Most importantly I like the fact that there are multiple types of patients where you have to bring different skills to bear. The challenges of treating minor injuries (technical, anatomical and logical skills needed) alongside patients with critical illness (physiological, pharmacological, intuitive skills) is a joy and means that you can often take refuge and respite in different types of patient and intellectual challenge all in one day.
Ruth Brown
From the moment I walked in St Mary's ED on my first day as an SHO I knew I was hooked - the noise, the variety, the edge of reason and I was sure it was right for me.
Diana Hulbert
The variety, being streetwise and being that rarity, a generalist. Working in an area where being good at basic clinical examination count! Doing things and not having to sit in long clinics subject to 18 weeks etc etc. I can cope with a 4 hour pressure.
Andrew Volans
I did a lot of outdoor pursuits when I was younger, and had to make some hard choices in terms of my future career. Fortunately I made the right decisions! After graduating from medical school I initially thought I wanted to be a surgeon, but I'm better now! Actually, I realised that I didn't like the artificiality of operating theatres and the need to perform repetitive technical tasks. EM is much more diverse and mentally challenging.
Jonathan Benger
I was a fully committed orthopaedic surgeon before I saw the light - and one day woke up and realised that I didn't want to go to work with the whole day planned. Practical procedures are still something I enjoy and I sometimes look at an X-ray in a patient with a fracture and itch to try to fix it, but the bonuses of EM far outweigh any lingering fondness for the operating theatre.
Ruth Brown
In those days doing FRCS and a surgical entry was the norm - these days I would have to do ACCS!
Diana Hulbert
Physiology degree before medicine, Anaesthetics and passed DA, FRCS and a year as registrar in Orthopaedics, three years in Neurosurgery, Locum posts in EM then Medical SHO with ITU, GP to expand my medical experience and then a training scheme in EM.
Andrew Volans
I work in co-located adult and children's emergency departments seeing 65,000 and 28,000 patients per year respectively. They are located in an urban inner-city population with significant social and drug problems. There are dedicated adult and paediatric observation units. Both departments have a large emergency nurse practitioner service, and extended scope physiotherapists in the adult ED. Departmental interests are in paediatrics, airway management, ultrasound, pre-hospital care and teaching.
Jonathan Benger
Tertiary Neuro centre and teaching hospital, inner city caseload sees 78,000 per annum. Children's observation and assessment unit due to open April 2008 due to the imminent closure of the local children's hospital.
Fiona Lecky Scarborough is a Holiday town on the East Coast. The population served varies from 22,000 to somewhere over 300,000. We see 39,000 new cases in the DGH and have three Minor Injuries Units (MIUs) that feed major cases from their 36,000 attendees. We have close relationships with the local Search and Rescue (SAR) helicopter base. I work with one other Consultant and an Associate Specialist.
Andrew Volans
What does your job plan entail? Full time post and then some more! My job is split three ways between the acute trust (United Bristol Healthcare Trust: 5 sessions), a large university (University of the West of England, Bristol: 4 sessions) where I lead the emergency care research programme, and the regional ambulance service (Great Western Ambulance Service: 3 sessions), where I am medical advisor to the air operations strategy and responsible for medical provision in the air support unit and critical care service.
Jonathan Benger
Full time but 50:50 University / NHS split. 3.75 DCC sessions which covers weekends, on call and 2 shop floor sessions per week, plus management and teaching. During the University part of my week I supervise my 4 post grad students doing PhD/Masters on trauma data from TARN and other sources and as TARN research director help clinicians from TARN hospitals use the data for research.
Fiona Lecky
We share shop floor activities. We give a 3 session presence at weekends on a 1:3 basis, and we lead the trauma team with some help from a consultant in surgery, orthopaedics and anaesthesia. We currently lead on stroke thrombolysis and have treated 80 cases so far with good results.
Andrew Volans
I got the trauma research bug back in the 1990's when I was lucky enough to get funding to do a PhD looking at markers of shock in trauma patients, I quickly understood how many myths our teaching is based on and have wanted to help improve the evidence base ever since
Fiona Lecky
Education - developed as Postgraduate teaching cert when a registrar completing a masters in medical education when a consultant. Mainly practice both locally as the Clinical tutor and as part of my role in the College. Protecting time and space to do the delivery of education and interact with trainees rather than the systems and management of education is increasingly difficult, let alone protecting clinical time.
Ruth Brown
I have a Diploma in Medical Education and am currently studying for an MPhil in work place based assessment. I am specifically interested in how doctors develop their higher cognitive functions.
Derek Burke
Sports Medicine - I developed my interest after I finished as an international rower (I competed in the Olympic Games in Sydney 2000). Then I did a sports medicine MSc and got involved with the GB rowing team as one of the team doctors. It was very useful for managing injuries in the ED and great management experience, and a good way of staying in touch with sport.
Ali Sanders
Pre Hospital Care. This had always got my attention as a challenging and exciting area of medicine with the opportunity to 'take the emergency department to the roadside'. My initial involvement was covering sports events such as the London Marathon and London Triathlon. I then went on some shifts with local ambulance crews and passed the diploma in immediate medical care. London HEMS is the most challenging job I have ever done. The trauma exposure is massive and we always strive to operate to the highest standards no matter how difficult the circumstances are that we are operating in. There is almost no reliance on investigations- it all comes down to clinical judgement, rather like Emergency Medicine used to be. This takes you back to diagnosing injuries clinically and on the history, and thinking about the physiology involved. In many cases we can make a real difference to outcome by solving airway and ventilatory problems in the first few minutes, therefore minimising end organ damage. A lot of effort also goes into careful packaging and patient movement to minimise clot disturbance and therefore minimise bleeding.
Ali Sanders
Although major trauma does not happen every day it is the biggest killer of children and young adults. Of those reaching hospital alive 50% of deaths occur on the first day - if we get it wrong in the ED the consequences are likely to be disastrous…. If we get it right it makes a huge difference to families and society.
Fiona Lecky - Consultant
Education and enabling others to develop themselves is the key to the future of EM, if we don't stimulate and inspire the next generation, and equip them with the skills for the clinical care of patients, then we will not survive as a specialty.
Ruth Brown - Consultant
Training is core to ED work, we need to know how to effectively deliver training within a 24 hour a day seven day a week service delivery based specialty.
Derek Burke - Consultant
The London HEMS system has a very high standard of clinical governance with all missions being evaluated extensively by our peer group and an experienced pre hospital care consultant. This serves the purpose of debriefing, reflecting and learning from every case. It is a very attractive specialty- both scary and exciting! The multi disciplinary team 'on scene' can be both fun and challenging. It's hard to imagine how you could ever be good at it- there is so much involved with each case and this keeps you hungry for more opportunities to get better. No two cases are ever the same which is true in the ED but much more acute in the pre hospital environment where every scene throws up new challenges. There is also the opportunity to make a huge difference to the morbidity and mortality of trauma patients- this can be very rewarding. It can also be quite harrowing and upsetting far beyond the emotions you feel in the ED. This means you need to learn really good strategies for coping.
Ali Sanders
Solving clinical conundrums, teaching - the endless variety!
Robin Touquet
I know it's really geeky, but I really enjoy learning new things, and also showing myself that I know stuff too. However, I find the best bits to be in the resuscitation room. Making decisions; coordinating with everyone; supporting staff and the banter with other specialties' doctors. You really have to work as a team in resus and when it goes well it is a good feeling.
Kasyap Jamalapuram
Successful difficult resuscitations. Breaking bad news in the best possible way so that something relatives/friends will remember forever is done in the most sensitive way possible. Teaching others and mending 'minor' injuries so patients can carry on with their day!
Ali Sanders
Management - I was a Clinical Director for 16 years (single handed for 5). Now I'm 60 and have 5 excellent consultant Colleagues!
Robin Touquet
Not always knowing what happens to the patient afterwards. Being limited or frustrated by hospital politics and difficult people. Other doctors being obstructive and looking down their nose at me when I make a referral because I'm just the "Cas officer". I know when we phone it generally means more work for the other person but show some courtesy!!!
Kasyap Jamalapuram
Ever increasing numbers, the 4 hour target and inadequate planning in the rest of the healthcare system which mean things don't run smoothly.
Ali Sanders
Friends, family, exercise, holidays - the odd glass of wine all help. Your other consultant colleagues are also really important.
Fiona Lecky
I sail, walk the dog and let the air force spoil me when I train their paramedics.
Andrew Volans
Learn to switch off from work. Learn to say no. Enjoy good wine. Go running. Grow vegetables!
Ali Sanders
Four hour target (of course) has transformed us into a specialty that potentially has a major voice in the hospital workings - we need to use that locally to ours and the patient benefit. Better structured training - so we know what we are supposed to be able to do and how to learn it. Nurse practitioners and GPs working in minors - profound effect on the skills of our juniors - and not always to the better.
Ruth Brown
Multi-Consultant departments - larger but fewer.
Robin Touquet
The development of Paediatric Emergency Medicine and Academic Emergency Medicine.
Derek Burke
We are one of the few specialties embracing a consistent 24/7 level of care whilst others retreat from it. This, coupled with the value that the public continue to place on emergency medicine, means that we have nothing to fear. Rather there are enormous opportunities for those who are prepared to continue to change and innovate. The future is bright!
Jonathan Benger
I believe we must push to maintain our role at the centre of the emergency pathway - and the gatekeeper of the hospital, but must ensure we do this by proper clinical management - not just see and sort to specialty. If we don't stand up, be counted, and contribute to the reconfiguration debate, we will lose our role in that pathway.
Ruth Brown
Future prospects are excellent, as our patients will dictate the need for us whatever politicians may say.
Robin Touquet
Developing the Clinical Decision Unit (CDU) model and improving the care of the acutely presenting patient.
Derek Burke
Emergency Medicine is an exciting specialty that gives you the opportunity to keep a good general knowledge of most specialties and opens up the scope of where you can develop a specialist interest. Most EDs are a great place to work, with lots of banter and fun to be had. It's an up and coming field that encourages people with dynamic personalities and good people skills to join the "family".
Kasyap Jamalapuram
EM is challenging, frustrating, entertaining, charismatic and worth it!
Diana Hulbert
When working in the NHS you have to take a long view (things are better now then 10 years ago), draw up a long term plan but put in short term objectives so you don't lose heart. Never lose touch with the shop floor, your credibility as a consultant depends on what you did this week not last year and finally when the administration and meetings are getting you down put your pyjamas on and go down to the shop floor to gain perspective on what it is all for!
Derek Burke
