Fred Wenger, DO, Albert Einstein Medical Center, Philadelphia

 

Senior medical students entering a career in emergency medicine (EM) and applying to EM residencies are generally most concerned with getting into the EM residency of their choice. Most give little thought about what type of EM career they will pursue after residency. During their training EM residents are given many opportunities to teach at the patients bedside, during morning report, and in the form of a formal lecture. Those enthusiastic residents that appear to have an aptitude and enjoy the experience of teaching may find themselves encouraged by their EM faculty to consider a career in "academics". This may be the first time that the EM resident has considered a career in academic EM.

 

Most emergency medicine programs graduate residents that pursue a career in clinical EM. Despite the expansion of EM residency programs in this country the employment opportunities in EM are still heavily weighted towards the practice of clinical medicine. 120 EM residency programs will graduate over one thousand residents this year. The number of graduating EM residents in one year is approaching the total number of faculty positions in EM residency programs. The majority of the graduating emergency residents find employment in the (4900) non-teaching community hospitals.

 

What is academic EM?

Academic emergency medicine is about the pursuit of scholarly activities that promote the field of and improve upon the body of knowledge that is emergency medicine. Successful academic EM faculty develop an area of expertise or emphasis within the field of EM and perform research, publish, and lecture in this. Common areas of expertise include resuscitation research, toxicology, resident, and medical student education, clinical and basic science research, and EMS.

 

Where do academic EP's work?

The opportunity to practice academic EM is most easily accomplished as a faculty member of an EM residency program. EM residency programs are not the only place to find academic EPs. Clinical educators are common in EM and many of these individuals make outstanding contributions to EM. A real limitation to academic productivity is protected time.

 

What is non-clinical protected time?

This non-clinical time provided to faculty to purse an area of academic interest. Protected time is provided to many academic faculty to pursue scholarly activities. Large amounts of clinical responsibility (direct patient care) may limit the time available for scholarly productivity. EM programs may require that a new faculty member "earn" protected time by first demonstrating a level of academic productivity.

 

What are the clinical responsibilities (direct patient care) of an academic emergency physician?

The clinical responsibilities of an academic emergency physician are often the same as a clinical emergency physician. Academic faculty typically provide less direct patient care than full time clinical emergency physicians. Both the number of clinical hours and also the nature of the patient encounter are different for the academic emergency physician. The academic emergency physician most often functions as a supervisor of residents and evaluates the patient only after the resident or student has had the opportunity to perform a history and physical examination on the patient. The involvement of the academic emergency physician with direct patient care is variable from program to program.

 

What are the nonclinical (nonpatient care) responsibilities of an academic emergency physician?

The nonclinical responsibilities of an academic faculty member vary from program to program. Minimal requirements for most academic faculty include teaching residents in the ED, providing formal lectures to the residents and faculty, publishing in the field of EM, involvement in research, administration, and grant writing. The procurement of extramural funds to support protected non-clinical time is strongly encouraged by most academic EM departments.

 

What are the advantages of a career in academic EM?

The practice of academic EM can be exceptionally rewarding and satisfying. Involvement in EM education and research exposes the emergency physician to the brightest and most influential minds in the specialty. The opportunity to improve patient care on a large scale and to change practice patterns is exciting and gratifying. As an academic emergency physician you have the opportunity to become the expert in the niche that you create for yourself.

 

What are the disadvantages of a career in academic EM?

While the total clinical hours is less for the academic emergency physician the total number of hours per week worked is usually greater for most academic emergency physicians. Salaries in academic EM have lagged behind those of clinical EM.

 

What are the implications for me as an applicant to an EM residency if I think I have an interest in academic EM?

EM residencies have their own strengths, weaknesses, and personalities. Some programs have developed a reputation as strong clinical programs while other programs are known for their research. Reputations of residency programs have a tendency to be self-perpetuating. Academic faculty and residents gravitate towards programs with reputations that reflect their interests.

 

Students with an interest in academic EM should apply to academically productive residencies. Academic mentors are helpful and are best found in active and productive residency programs. The prospective residency applicant interested in academics should determine the percentage of graduating EM residents that choose a career in academic EM.