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:
- Providing hands-on clinical care in Emergency Departments, Clinical Decision Units, clinics, and other settings such as the pre-hospital arena, minor injury units
- Supervising clinical care provided by others in the same settings
- 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
- Teaching doctors, nurses, ambulance staff, and other health professionals across many different specialties as part of educational programmes, and on life support courses
- Engaging in research activity
- Getting involved in medical management within hospital Trusts to set up integrated systems of emergency care (e.g. trauma systems)
- 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.