Motivations for a career in emergency medicine: a profile of the 1996 US applicant pool.

INTRODUCTION: Although some studies have tried to assess the factors leading to choice of specialty, none have been specific to emergency medicine (EM). With a doubling of the number of EM residency programs in the past decade, an assessment of the career motivations of residents is in order. OBJECTIVES: To identify and rank the factors that lead candidates to choose EM as a career. METHODS: Fifty-four participating EM programs returned a total of 393 anonymous surveys completed by their 1996 National Residency Matching Program (NRMP) interviewees. The survey asked respondents to rank 12 factors on a 5-point (0-4) Likert scale. RESULTS: Respondents ranked the 12 motivating factors in the following descending order of importance: diversity in clinical pathology, emphasis on acute care, flexibility in choice of practice location, flexibility of EM work schedules, previous work experience in EM, greater availability of EM faculty for bedside teaching, strong influence of an EM faculty advisor or mentor, relatively shorter length of training, better salaries for EM than for primary care specialties, the presence of an EM residency at the student's medical school, perception that EM residents have more time to moonlight and popularity of EM among medical students. CONCLUSION: US applicants appear to choose a career in EM largely because of clinical factors (diversity of clinical pathology and emphasis on acute care) and practice-related factors (flexibility in practice location and schedule).

Emergency medicine residency applicant educational debt: relationship with attitude toward training and moonlighting.

OBJECTIVES: Heated debate persists regarding the role of resident moonlighting in emergency medicine (EM). The attitudes of EM residency applicants have not been assessed. The objectives of this study were to assess: 1) the level of educational debt among EM residency applicants, 2) their perception of increased risk potential to patients from unsupervised EM resident practice, and 3) their opposition to laws restricting moonlighting. The authors then report the relationship between the degree of indebtedness and these stated positions. METHODS: Fifty-four EM residency programs returned 393 responses to a 1996 anonymous survey. Applicants recorded: 1) their indebtedness, 2) whether they believed that EDs should hire only physicians who have completed full training in an EM residency, and 3) whether they believed that unsupervised EM practice prior to completing EM training carries a higher risk of adverse patient outcomes. The authors used a t-test and logistic regression to determine whether there was any significant difference in debt between responders who answered yes and those who answered no to the various questions. A p-value < 0.05 was considered significant. RESULTS: The mean +/- SD debt was $72,290 +/- 48,683 (median $70,000). Most EM applicants (84.8%) agreed that unsupervised medical care by EM residents carries a higher risk of adverse patient outcomes. Paradoxically, only half the applicants opposed a moonlighting ban. Responses did not statistically correlate with educational debt. CONCLUSIONS: Emergency medicine residency applicant debt is large. The EM applicants' opposition to laws that would restrict moonlighting was mixed. This was inconsistent with the majority acknowledging an increased risk potential to patients. Nearly all EM applicants would still select EM as a career, even if moonlighting were to be banned.

Earthquake epidemiology: the 1994 Los Angeles Earthquake emergency department experience at a community hospital.

INTRODUCTION: To assess the volume of patients and the composition of their injuries and illnesses that presented to an emergency department (ED) close to the epicenter of an earthquake that occurred in a seismically prepared area. METHODS: A retrospective analysis of data abstracted from charts and ED logs for patient census and types of injuries and illnesses of the patients who presented in the ED of a community hospital before and after the earthquake (6.8 Richter scale) that occurred in 1994 in Los Angeles. Illnesses were classified as trauma- and non-trauma related. Data were compared with epidemiological profiles of earthquakes in seismically prepared and unprepared areas. RESULTS: A statistically significant increase in ED patient census over baseline lasted 11 days. There was a large increase in the number of traumatic injuries such as lacerations and orthopedic injuries during the first 48 hours. Beginning on the third day after the event, primary care conditions predominated. When the effects of the LA quake were compared with those of similar Richter magnitude and disruptive capability, the ED epidemiology profile was similar to those in seismically unprepared areas, except for the total number of casualties. CONCLUSION: The majority of patients with traumatic injuries presented within the first 48 hours. The increase relative to baseline lasted 11 days. Efforts to develop disaster response systems from resources outside the disaster-stricken area should focus on providing mostly primary care assistance. Communities in seismically prepared areas could require external medical assistance for their EDs for up to two weeks following the event.