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Interview Season in Emergency Medicine

December 4, 2009

There is a season for everything in life. As well as being the holiday season now is the peak of interview season in medicine. It is the time when many young and well trained residents set out in the world looking for that one elusive goal; the perfect job. Of course everyone knows there is no “perfect job” as what is perfect for one person is a terrible job choice for another. It all depends on what you seek. Is the job in medicine to be academic or community? Do you want to practice in an underserved area, urban or suburban setting? Is your wish to move back home to be close to family or set off and see the world?

The great thing about being in emergency medicine is that the skills and talents you possess are in demand just about wherever you go. I have had the opportunity to give a lecture on searching for the right job to several residency programs. What I try to stress is more than the salary you are offered (okay that’s probably #1 or 2 after your several years of indentured servitude and mountain of debt you’ve accumulated) is the dynamics and culture of the group you will join. Is this a group that seems happy? Considering you are planning to spend the better part of your waking hours with this group of individuals you might at least want to make sure they like one another. Secondly is this a place where you can see yourself in 5 years? Is there opportunity for advancement or potential for finding a “niche” for yourself? I love being a clinician and mixing it up over time is probably the best way to maintain longevity in emergency medicine. Whether that niche be EMS, research, public policy, pediatrics, ultrasound, hyperbarics or leadership it will serve you well to explore the potential as you interview.

Another important aspect of emergency medicine is where it stands in the hospital “food chain”. Is the ED a poor stepchild getting the castoffs from other departments? Look around and you will see during an interview where the department stands. Besides the physical plant, which says a lot in itself, look at the technology in the department. Is there a sono machine that the ED uses for bedside studies? Are there enough computer stations or are you jockeying with the private medical staff for space? Does the difficult airway cart rest in a single laryngoscope blade or is there an assortment of LMAs and fiberoptic laryngoscopes at your disposal? No department is perfect and most are underbedded but is there an acknowledgment by hospital leadership that the ED is indeed the front door to the hospital and there is an attempt to make it a good first impression?

Finally I would ask about what feedback mechanisms are in place and how success is to be measured. How many patients per hour to see or RVUs per hour am I expected to generate? Granted this is very dependent on the acuity of the department but at most places if you can comfortably treat, on average, over 2 patients per hour you should be fine. When you are expected to see over 3 patients per hour, in a high acuity facility, without an assistant or scribe then I would be very skeptical of the position. Ask about the form of feedback. Besides the typical as your Director catches you coming in for your shift “Uh Ang I want to talk with you about the patient you saw last night”. Never a good way to start a shift! Will you have access to personal data and productivity on a regular basis? Will I have an opportunity to sit down and measure my progress with someone to help me improve?

There are so many jobs and so many things that can be hidden from an interview. Be honest with the person with whom you are interviewing and expect them to be honest with you about problems in their department. As Ronald Reagan is famous for saying “trust but verify”. Ask what is the biggest problem currently and what is the plan to fix it. Every department has issues. The key is there a plan on making the situation better and improving the level of care provided to their patients.

Good luck and have fun! It is a great time to be searching for a job in emergency medicine.

Angelo Falcone, MD

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