Careers in Emergency Medicine



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.

The Royal College of Emergency Medicine has a Careers Group, which has produced the guides below for anyone considering a career in EM.

Emergency Department - Overview



Working as a Consultant or SAS Doctor

Find out more about working in these roles in the drop down menu below.

Being a Consultant Emergency Physician is a challenging job. It is hard to define exactly what a Consultant Emergency Physician does, because there are so many facets to the role. One could argue, however, that our core role is to work towards the provision of the highest standards of emergency care in Emergency Departments, hospitals, and in the wider health community. In addition Emergency Physicians might undertake roles supporting injury prevention.

Emergency Physicians achieve their role in a number of ways, including:

  1. Providing hands-on clinical care in Emergency Departments, Clinical Decision Units, clinics, and other settings such as the pre-hospital arena, minor injury units
  2. Supervising clinical care provided by others in the same settings
  3. Leading and managing Emergency Departments, most importantly ensuring that systems are in place to ensure that the quality of care is as good as it can be. This includes guideline development, audit and clinical risk management
  4. Teaching doctors, nurses, ambulance staff, and other health professionals across many different specialties as part of educational programmes, and on life support courses
  5. Engaging in research activity
  6. Getting involved in medical management within hospital Trusts to set up integrated systems of emergency care (e.g. trauma systems)
  7. Getting involved in the design and provision of emergency care within the health community as a whole by working with Primary Care Trusts and other health care providers.

  
A typical day for an emergency physician might involve combining any or all of these roles .... making for a pretty variable working life. 

Emergency Physicians are specialists  in resuscitation and the initial management of trauma, “minor” injuries, major incident management, front door diagnostic and treatment strategies, and short stay / observation medicine. We are the only professional group with sufficient flexibility in our clinical skills to be able to initially assess and manage the broad range of acute presentations that present to Emergency Departments, across the age and acuity spectrum. In addition some Emergency Physicians choose to sub-specialise in areas such as paediatric emergency medicine, toxicology, acute medical emergencies, critical care medicine, prehospital medicine, and sports medicine. This broadens the expertise available in Emergency Departments.

Emergency Medicine (EM) is a relatively new specialty, and although we know what we can do, it is taking time for others to catch up. Today’s consultants are to some extent working to define their role. Because we work at the interface of primary and secondary care, and possess skills which overlap with those of many of our clinical colleagues, there can be blurring at the interfaces with EM consultants sharing skills traditionally only found in in-patient specialty consultants. Current examples include advanced airway management and procedural sedation, the use of focused ultrasound, care of “minor injuries,” and care for patients with acute “medical” problems both within Emergency Departments and on Clinical Decision Units. The key to success in fulfilling our potential will lie in building relationships based on mutual respect. This will stem from our ability to lead the provision and delivery of high quality emergency care. Emergency Physicians spend their whole clinical life working in teams, and therefore tend to be self-selected team workers. We must also be excellent leaders, negotiators, clinicians and managers.  

Because Emergency Medicine is a 24/7 specialty, Emergency Physicians tend to work at least some shifts in the evenings and weekends. The work can be of a high intensity, and in busy departments can be unrelenting. There is a high management and teaching workload compared to most other specialties, since the essence of successful departments is a strong quality framework, led by Emergency Physicians along with their nursing, management and other colleagues. The consultant contract wasn’t designed with Emergency Medicine in mind, and it can sometimes be difficult to reconcile the realities of the consultant working life with a job plan seeking to compartmentalise time into well-defined categories, with limited recognition for working antisocial hours, and the perception that “direct clinical care” can only be provided facing the patient. 

Our specialty is developing, as our health care system is changing, and as medicine increases in its complexity. As the NHS matures, Emergency Medicine increasingly demonstrates its contribution to patient care and its essential place in the system.

Emergency Physicians therefore need to be up to adapting to the needs of the NHS today. The job now is very different to how the job was 10 years ago, and it may well be different again in 10 years. However, if you are looking for a specialty where you are a specialist in emergency and acute care, seeing patients of all ages and with a huge variety of presentations, and with the opportunity to sub-specialise in a number of exciting fields, then becoming an Emergency Physician could be for you. You will need to enjoy working in a skilled multidisciplinary team, be committed to the concept of quality, look forward to supervising and teaching a wide range of learners, and want to contribute both clinically and managerially at many levels across a variety of organisations. One thing’s for sure. You will have to work hard, but you certainly won’t get bored.

The Staff and Associate Specialist Doctors’ group represents a considerable proportion of the senior doctors working in Emergency Medicine in the UK. Exact figures are hard to collect, but in 2005 it was thought that there were over 800 doctors in these posts. In 2002, the BMA established SASC, the Staff and Associate Specialists Committee, to represent the needs of this group of doctors.

The main members:

  • The Staff Grade was introduced in 1988. At the time of its introduction, the intention was that Staff Grades would be doctors who helped meet service requirements whilst bridging the gap between Consultant level staff and Junior Doctors in training. The posts were intended to provide a secure, well-remunerated and well-supported option for those medical staff wishing, for a variety of reasons to continue to work in hospitals whilst choosing not to pursue completion of full higher specialist training.
  • The Associate Specialist grade (initially entitled Medical Assistant grade) was introduced in 1964 and re-named in 1981. These doctors are senior clinicians, responsible to named consultants, although they frequently work at the same level as their consultants, as do a number of Staff Grade doctors.

In the 1990s, a national ceiling limiting the number of Staff Grade posts was removed and there was a rapid increase in the number of Staff Grade posts in many specialities, especially the acute specialities such as Emergency Medicine.

Other members of this group:​​
  • Clinical Assistants (part-time medical officers) are doctors working on a sessional basis. National terms and conditions of service are not clearly defined and it is recommended that such posts should be converted to Staff Grade posts.
  • Non-Standard Grades: In recent years, many trusts have faced restrictions on the allowed proportion of Staff and Associate Specialist doctors at the same time as needing more medical staff. One way around this has been to introduce new grades of doctor, e.g. a Trust Grade doctor. These positions have non-standard terms and conditions of service and are looked on with disfavour by the BMA

What are these jobs like?
This is a very difficult question to answer. From some members of the group, one hears stories of job satisfaction, whether working full or part-time, being made to feel a valued member of the team, opportunities to pursue special interests, a share of management responsibilities and adequate educational opportunities. At the other end of the scale, there are stories of lack of appreciation from senior colleagues, solely shop-floor working, especially anti-social hours, and no educational or training opportunities.
Over the years, other groups of colleagues have had new contracts and new pay deals, while this group has not. This has led to situations where a senior SAS doctor may be supervising a junior doctor who is earning more than they are.
Negotiations for a new contract have been going on for several years – at the time of writing, in January 2008, this process is still going on and the proposed new contract  is about to be circulated to all SAS doctors who will then have the opportunity to vote for or against it. Details of the new contract, including step by step comparisons between it and the existing contract, are available on the BMA website.
 
Can I move onwards and upwards from one of these posts?
It is possible to apply through PMETB to have one’s qualifications, training and experience recognised so that one can apply for consultant posts. This is a lengthy process, but several of our Associate Specialist doctors have stayed the course and have now been appointed to consultant posts. For those with less experience, who would like to move from a SAS post into the new speciality training system, it is too early to say exactly what degree of difficulty would be encountered.

Should I consider one of these jobs?
It is not all doom and gloom. Some of us are very happy with our jobs (although, like anybody else, we wouldn’t say ‘No’ if someone offered us a pay rise) or feel that we are able to negotiate changes and improvements for ourselves. The new contract certainly offers some improvements, but not all the improvements many had hoped for, and requires careful study.
Perhaps the best advice one can offer to someone considering a career as a SAS doctor is to make sure they find out as much as they can about the department they would be working in, ideally from someone already in the job. One also needs to remember that to a certain extent, a job is what you make of it.​​

Career Days

The Career’s Group also organises Careers Days at the College, and representatives from the group attend careers days for medical students around the country.

The EM Careers Day is informative event aimed at Medical Students, Foundation Trainees and anyone interested in a career in Emergency Medicine. It gives delegates the opportunity to ask questions, engage in workshops and listen to some stimulating talks from the experts about their experiences of Emergency Medicine. Attendance such events shows a commitment to the specialty for anyone planning to apply for EM and may help bolster applications, as well as providing a taste of what a typical working day might involve. 

We will be running two Careers Days in 2017, so please email us if you would like to be emailed details nearer the time or have any questions. 

To view the sample programme for the careers day, please click here.

For details of upcoming Careers Fairs RCEM that reps will be attending, or if you're organising a fair and would like to invite representatives from the College, please e-mail careers@rcem.ac.uk.

Representatives from RCEM will be attending the following fairs: 


Past fairs attended: