It seems that there are so many emergency medicine job opportunities, yet so few long-term stable emergency physicians in jobs.
Much of this has to do with the ever-changing practice environment and at times tenuous relationship with the hospital, consultant medical staff, and regulatory bodies.
Resultantly, stability even for the seemingly most sought after emergency medicine jobs is never assured or guaranteed.
In this article, the author explores common practice challenges for emergency physician jobs in today's healthcare environment.
Today, emergency physicians find themselves working in a crisis environment.
This is largely a result of our Nation's emergency departments (EDs) are the only sector of the healthcare system where there is a federal statue mandating that care is provided to all patient regardless of their ability to pay.
Imagine if you will, a law requiring all of those fast quick lube shops to take all motorists, regardless of their ability to pay! Between the years of 1994 and 2004, ED visits increased from 93.
4 million to 110.
2 million-an 18 percent increase.
Meanwhile, there was a significant decline in the numbers of hospitals, hospital beds, and emergency departments.
The resultant overcrowding long waits, coupled with an under supply of ancillary support, makes for a crisis work environment.
Emergency physicians will also find that the rest of medical community inadvertently exacerbates the existing crisis.
The perceived need for hospitals to funnel as many patients as possible through their EDs cripples many tenuous EDs both financially and medically.
Primary care delivered in the ED is more costly than providing the same care in a physician's office, and primary medical care received through the ED is of poorer quality.
Emergency Physicians have extensive training in medical and surgical emergency management and treatment, however, primary care is best reserved for Family Medicine, Internal Medicine, and Pediatrics.
According to the National Hospital Ambulatory Medical Care Survey , 47% of emergency department visits in 2004 were classified as either emergent (12.
9 percent) or urgent (37.
8 percent).
The delivery of primary care in the ED for non-emergent patient care contributes to ED overcrowding, patient boarding, ambulance diversion, and delayed ambulance response times on a daily basis.
Resultantly, this severely limits the system's ability to prepare for and respond to a catastrophic medical disaster, natural disaster, pandemic or terrorist attack.
Emergency physician are finding it increasingly difficult to obtain much needed on call assistance for patients needing hospitalization.
This is largely because of uncompensated or undercompensated services provided by on call specialist, coupled with rising unresolved medical liability and regulation.
Although once attractive for new graduates, most new physicians now prefer the security afforded by larger well-established groups to the financial vagaries and lifestyle restrictions of solo practice.
In so doing, taking ED call becomes more of an unwanted burden than an opportunity.
The burden is worsened when other factors not previously mentioned are considered.
For example, the ever-present medical malpractice threat looms over emergency medicine.
Nowhere else in medicine can the actions of one specialist always be criticized by what is viewed by the lay public as a true specialist in anther specialty.
Despite being the best person to manage for example an emergency airway, the ED physician will always be subject to the 'definitive' opinion from the true expert - the anesthesiologist; as well as the cardiologist, gastroenterologist, neurologist, etc.
Likewise, the pressure of benchmark performance, throughput, volume and acuity of patients seen per hour, patient satisfaction, patient complaints and admission rates all weight into the equation.
The emergency physician also must balance not only the patient as the 'customer' but the medical staff, hospital administration, and to some extent the nursing staff as well.
Whereas in other aspects of medicine where the nurse works subordinate to the physician; often in the ED, due to supply and demand, nurses are having an increasingly louder voice in influencing the practice and judgment of physicians in the ED (which may in fact be a good thing for many department and physicians).
Nonetheless, this too affects the emergency physician job.
In general, today's emergency physician is faced with numerous challenges and stressors making for crisis in the workplace.
This crisis directly affects the likelihood of emergency physicians finding lasting stability, in a given practice location in most cities in the US.
Federal support and intervention is needed to release the mounting pressure that currently worsening.
The Institute of Medicine, American College of Emergency Physicians, and similar institutions are taking great strides in leading change - none of which can come all too soon.