EM – the Good, the Bad, and the Ugly

This essay is aimed at medical students contemplating a career in Emergency Medicine. If you are an EM resident you may also find it useful in terms of helping you identify “red flags” when you go job hunting.

Any resident in EM or student interested in EM should read The Rape of Emergency Medicine. Published by in 1992, this book was written by then anonymous “Phoenix”, later identified as Dr. James Keaney. This book was really an eye-opener for many people, including yours truly. It revealed the dark side of EM practice. The book is now available for free download at http://www.aaem.org/rem/The_Rape_of_Emergency_Medicine.pdf. The main thrust of the book is to convey the exploitative nature of working conditions for many emergency physicians. The basic theme is this – business savvy physicians, by means fair or foul, can sometimes get a hospital to contract with them for ED coverage. Once they “own” the contract they then do everything in their power to maximize their “profit”. The profits consist of the difference between what they pay the docs doing the real work and what they can collect from the patients. The book explains better than I can how this negatively impacts the physicians life and career, and more importantly, the patients well-being. Awareness is the key to avoid being exploited in this way. Approximately 40% of EM jobs in the current market are exploitative – that is perhaps the biggest negative about EM as a specialty career. If you want to work in certain areas, jobs with these contract groups may be all or most of what’s available. So again, my strong advice is to download and read the book.

With the ugly out of the way, let’s talk about the good and the bad. Interestingly, these are often two sides of the same coin. Whether they are good or bad depends on your personality, life style, and the stage of your career and life.