Author: Allison Tu
About me: I’m a second-year medical student at NYU planning to pursue a career in emergency medicine. I graduated from Harvard in 2023 with a degree in psychology and global health, and during medical school, I’ve co-directed NYU’s asylum clinic and volunteered for the suicide prevention lifeline. I am also interested in teaching, and I hope to pursue a medical education fellowship in the future. Outside of medical school, I love social dance, baking, and long-distance running.
To get a sense of how medical students feel about emergency medicine, we interviewed three students who are interested in EM: Nick, a graduating M4 pre-matched into EM residency, Charlotte, an M2 currently planning to pursue EM, and Annie, an M1 considering EM.
What sparked your interest in emergency medicine?
Nick: My interest in EM began when I was working in EMS as an undergrad, and I was always pretty committed to the field. I enjoyed the approach to the undifferentiated patient and the challenge of ruling out worst-case scenarios. The role of the emergency room as part of the social safety net and the importance of patient-provider interactions in this context also drew me to EM. During medical school, I did consider other specialties, but realized what I liked most about EM: being a generalist, always learning from the specialists you consult, and making the final call on patient care.
Charlotte: My interest in EM stems from the variety it offers – you see patients who have little other contact with the healthcare system alongside many high acuity patients. I also appreciate the culture in EM, which I’ve found to generally be down-to-earth and less hierarchical. There’s more focus on maintaining balance and interests outside of medicine, which I think is important for a sustainable career in medicine.
Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. I’m also passionate about advocacy, so I appreciate the focus on the social safety net. The culture is also great – I’ve heard crazy stories about surgeons with tempers, but have never seen that in the ED.
How does your medical school support interest in emergency medicine careers?
Nick: Throughout medical school, I noticed that most of the teaching, across the entire curriculum, is done by specialists rather than generalists. This setup encourages students to think about the cutting edge of each subspecialty, which is great, but I believe it’s more important for us at this stage to master the basics needed to be a good clinician. I usually had to seek out role models in generalist-type fields on my own.
Charlotte: The EM department does an exceptional job of supporting interest in the field. I had an early exposure to EM through shadowing shifts during my first year, and then participated in an EM summer fellowship program. These experiences helped me better understand the specialty and start envisioning myself in the field.
Annie: The EM department does most of the heavy lifting in supporting student interest. There’s minimal EM exposure in the curriculum, but as an EM Interest Group co-leader, I’ve seen how much effort the department puts in. They’ve set up amazing workshops and shadowing experiences, which were so valuable, especially given the condensed preclinical curriculum.
What have people said to you to discourage you from going into EM?
Nick: Over my years in medical school, doctors have expressed concerns about the high burnout rate, mid-level creep, unsafe working conditions, and insufficient compensation in EM. On the medicine floors, I’ve heard that EM doctors don’t engage in slow, methodical thinking. However, I think there’s room in the ER for both fast and slow thinking.
Charlotte: Most of the discouraging comments I’ve encountered concerning EM have originated from sub-specialty services on my clerkships. EM interacts with a variety of other divisions, oftentimes seeking consults or admissions, so I believe some of the frustration comes from the differing goals of each service. Similarly, I’ve encountered a bias towards physicians becoming increasingly specialized, while EM is one of the few areas in which broad medical skillsets are particularly important.
Annie: I think the general public’s perceptions about EM often focus on intensity of the work and the crazy traumas, so they’re concerned about burnout. I’ve run into the sense that EM really grinds on you, which I believe is a misconception, though I realize that might change as I spend more time in the ER.
If you end up not pursuing EM, what would be the reason(s) why?
Nick: EM is sometimes viewed as less academic, which is a concern for me. I enjoy reading studies, discussing their implications, and teaching, which is why I’m considering a critical care fellowship. It does seem like many MICUs and SICUs prefer to hire people who are IM or anesthesia trained, so that’s one drawback, but it was balanced out by a lot of benefits of EM. I strongly considered general surgery and internal medicine, specifically pulmonary critical care or cardiac critical care. Both fit the generalist aspect I enjoy, but I did not end up loving the OR. Internal medicine felt too slow for me, and I missed seeing cases like musculoskeletal injuries or pediatrics.
Charlotte: I’ve enjoyed different aspects of many clerkships, which sometimes made me consider other specialties. In particular, I enjoyed the detailed diagnostic exams in neurology, the interpretation of echocardiograms in cardiology, and the patient and family contact in OBGYN and pediatrics. The appeal of EM is that it incorporates aspects with each of these, in addition to providing critical interventions. I see the appeal of focusing on a single area of medicine in depth, but I always come back to EM.
Annie: As an MD-PhD, I’m passionate about research, particularly in basic science and neuroscience. EM definitely has less of that sort of research, so I’m grappling with the decision between pursuing a more academically research-oriented career or staying in EM. Of course, there are also plenty of EM physicians who do a lot of research, and I have plenty of time to figure it all out in the interim.
What do you view as the biggest challenges in emergency medicine?
Nick: Triaging your time and priorities as an ED doc on shift is so challenging. There’s always an endless list of tasks for you at any given time, plus more patients in the waiting room that need to be seen, and having the executive function skills to figure out which tasks take priority takes a lot of practice. It’s something I definitely haven’t mastered just yet, and might not master for a really long time.
Charlotte: I suspect that the biggest challenge I will face will be the combination of a high-volume and fast-paced work environment. In particular, I think the cognitive and mental burden of caring for critically ill and complex patients, and patients with significant social stressors, can stretch even very empathetic clinicians.
Annie: Insurance issues, such as the cost of medications and procedures, and disparities in healthcare access, especially in rural areas, are significant challenges. Despite EM being more diverse than other specialties, there’s still work to be done in making the field more inclusive and addressing overrepresentation of certain groups. Emergency medicine is uniquely positioned to tackle these issues, but it remains an elite profession with many systemic challenges to overcome.
What is your perspective on the 2021 job report?
Nick: The 2021 job report, which predicts an excess of emergency physicians by 2030, has encouraged me to think critically about my career. I’ve asked folks about their job search experiences and reconsidered other specialties, but I can’t see myself doing anything other than EM. However, I am considering pursuing some kind of fellowship to have a fallback option or to make myself a more competitive candidate. I’m thinking about a fellowship in addiction medicine or critical care.
Charlotte: I think the practice of medicine is always changing, and the responsibilities of each specialty will evolve, especially with advancements in AI. Despite the report, I think there will still be EM jobs available and that other fields may experience greater changes due to AI. EM is still the field that most closely aligns with my interests.
Annie: I wasn’t aware of this report until recently, and it hasn’t trickled down much to first-year medical students. The narrative has always been about a physician shortage, so I was pretty surprised. This might be the PhD student in me coming out, but I’m curious about the prediction models and factors they used, because emergencies happen all the time and there are plenty of rural places without enough healthcare. I’m taking it pretty neutrally and am interested to see how it plays out, especially since I’ll graduate in 2030.
What are your thoughts on the role of private equity companies in EM?
Nick: It is scary to hear the horror stories of what happens to hospitals and EDs taken over by private equity companies. In some ways I feel like the situation is a consequence of having a system that’s constantly being pushed to its limits. It seems like there is legislation coming to limit the amount of control that non-physician PE groups can have over ED care and staffing – I’m thinking of a particular ongoing lawsuit in Florida that seems to be a step in the right direction.
Charlotte: There’s been a shift in healthcare overall towards working for hospital or medical groups owned by private entities, which changes the incentives away from providing the best care. I’m glad that EM is recognizing this and discussing solutions, but the overall trend is concerning.
Annie: As someone who realizes the value of single-payer systems, it’s frustrating to see the US moving in the opposite direction. It’s very concerning, but I’m still hopeful that there will be improvements and perhaps regulations in the future.
Lots of Gen Z and millennials are getting most of their healthcare in the ED. What do we think about the increased burden of healthcare in the ED?
Nick: It’s definitely posing a new challenge to EDs, and possibly even expanding the skillset of ED providers to know more about how to treat more low acuity complaints. It also speaks to the low availability of primary care docs in certain areas and poses the need for better systems of linking folks from the ED to longitudinal outpatient care.
Charlotte: It’s tough because, while great PCPs are valuable for continuity, many young people struggle to find a PCP – I tried to find one myself and many physicians don’t have appointments for a year or more. Younger generations are also used to services being more on-demand, so more of them end up in urgent cares or the ED. Since I’m not working yet, I don’t know how it actually affects clinical practice, but I can see how the model fits better with Gen Z and millennials.
Annie: The narrative that more people are using the ED for healthcare highlights broader issues in the healthcare system, like the difficulty in accessing PCPs. While it can be frustrating, it’s important to understand that people come to the ED because they need help, even if it’s not strictly an emergency.
EM offers lots of flexibility to engage in other facets of medicine, from medical education to toxicology. What EM-adjacent fields might you be interested in pursuing throughout your career?
Nick: I’ve thought a lot about improving my future job security, which definitely includes potentially pursuing a fellowship. I’m interested in addiction medicine, which aligns with the ED’s role in the social safety net, and critical care, which is full of slower, detailed thinking.
Charlotte: Before med school, I worked in public health, and I see a lot of potential for implementing programs and conducting research related to public health in the ED. Additionally, I really enjoy ultrasound. While I might not pursue a formal ultrasound fellowship, it’s a valuable diagnostic skill that I’m aiming to develop during residency.
Annie: I only recently realized how many fellowships EM offers. I’m currently most interested in education, policy, and toxicology. The variety is exciting, and it’s truly wild how many opportunities there are. I think I might even pursue multiple fellowships, as there’s so much to explore and that happens to be an option.
What qualities do you view as being most important in an EM physician?
Nick: I think it’s important to be introspective of how you are thinking, switching between fast, intuitive system one and slow, deliberate system two. You have to be aware of what you’re doing and able to switch depending on what the situation calls for.
Charlotte: Above all else, I think adaptability is key. In EM we are often balancing clinical triage, resource limitations, social barriers, and the challenges of making first-impression diagnoses. It is essential to transition from task to task, monitor the board, proactively help peers, and prioritize actions efficiently. It’s also important to be able to bring your full self to each interaction, whether it is delivering safe discharge instructions or discussing a life-altering diagnosis.
Annie: Hard work, empathy, and resilience are crucial. You need to be quick on your feet and stay level-headed when chaos is around you, and have a huge breadth of information that you’re comfortable drawing from. It’s also so important to be able to work effectively on a team, given the collaborative nature of EM.
What qualities are most helpful to you in EM mentors, residents, and attendings?
Nick: In EM, people are generally very open and quick to share their genuine selves with mentees, which has helped me imagine my future career. Although we often work with an attending for just a single ED shift, people are great about understanding my goals for each shift and providing specific, actionable feedback. It’s clear that they want to help me become a better doctor.
Charlotte: I’ve had mentors in the EM department who are very thoughtful and understanding. This has been particularly important during my clerkship year, as I’ve been juggling many different commitments including applying for the three-year program (which admits med students directly to residency) during my surgery clerkship. The willingness of these mentors to be available, even giving me their phone numbers for any questions, has been so helpful.
Annie: EM physicians love students and are eager to help. I’ve attended several women in EM events, which are so wholesome, because you can really see the genuine care EM physicians and the department itself have for the students.
How do you anticipate adapting to and incorporating new innovations into your career?
Nick: In the future, I envision an emergency department with minimal physician-computer interaction, where documentation is fully automated, allowing us to focus more on medical decision-making. However, I think the element of clinician gestalt will remain irreplaceable, especially in making diagnoses where clinical decision-making tools are not fully reliable. I also think patient-provider interactions will still require a human touch – people come to the ED to be seen by a doctor.
There are also big implementation barriers to new technology in healthcare. Even with a perfectly functioning AI system, widespread adoption could take decades, just as EHRs have still not been universally implemented.
Charlotte: Documentation is the lowest hanging fruit for AI integration, but the more complex aspects of healthcare – decision-making and patient communication – are much harder to automate. Prior to medical school, students sometimes work as scribes because much of the documentation doesn’t require the same understanding of medicine or carry the same liability as making management decisions, which will be more challenging for AI to replace.
Annie: I don’t think AI will be fully integrated into healthcare anytime soon. AI has developed rapidly, but the necessary regulations and considerations haven’t kept pace. There are significant biases in AI data, like algorithms that spit out gender-biased results, which can lead to harmful outcomes. There’s a lot of buzz about using AI to lead patient care, but I don’t think it’ll happen to any significant extent for a while, beyond what’s already been implemented.
Imagine yourself at the end of your career in EM. What impact do you hope to have made?
Nick: I think at the end of the day, I just want to be a good doctor that’s thoughtfully treated a lot of patients and had an influence on a lot of trainees. I think a lot of people have aspirations to make enormous system-wide changes in their field, which is fantastic, but my motivations in medicine have always been on a more individual level.
Charlotte: Being realistic, I hope that I will have been an excellent EM doctor and positively impacted my patients. If I want to be ambitious, I hope to incorporate healthcare policy into my career, helping to shape laws and regulations that ensure that all patients receive the care they need.
Annie: Realistically, I want to be the best doctor I can be, always reminding myself that I’m doing this for the patients. Beyond that, I hope to explore what I can do with my PhD, possibly incorporating translational or basic science research into my career. I’m also interested in education and policy, as they all tie back to improving patient care. Alas, it’s early in my career, and I think I’ll figure it out more as time goes on.
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