You have decided to practice emergency medicine and are about to start your career. But what should you expect and what essential information do you need to know?

Working in the ED involves much more than just the clinical aspects of the job including understanding legal regulations, managing patient expectations, getting comfortable with hectic schedules and constant interruptions, and much more.

Becoming an emergency medicine physician is not for the faint of heart, but if it’s the path you’ve chosen, these ten practical aspects of working in the ED will help you start on the right foot.

1. You Will Open the Door to Care for Many Patients

Despite other doorways to healthcare — employer clinics, medical clinics in pharmacies, urgent care centers in strip malls — the emergency department is the front door to care in the hospital and may be the only encounter with the hospital some patients will ever have.

Not only is the ED the hospital's first line of care, but it is also the concierge desk and gateway through which most admissions enter. It's a door that's getting wider as the volume of ED visits increases thanks to a growing physician shortage, and patients' inability to receive care elsewhere.

2. You Will Serve as Both Specialist and Generalist

Emergency medicine is a specialty in principle, but you will serve as a generalist in practice.

You will take care of everyone from infants to the elderly, from non-emergent conditions to severe trauma, and everyone and everything in between. You will never know what to expect in a given shift, so be prepared to manage any condition and patient you encounter.

3. You Will Get Comfortable with Multiple Interruptions

As an emergency physician, you will be interrupted many times every hour. You may get a call from the lab one minute and the next have a triage nurse telling you a stroke victim has just arrived.

To survive, you must become a master parallel-process thinker who can pivot quickly and address multiple (and often critical) concerns in a short span. That's not to suggest that you'll spend every minute of your shift managing chaos, just that it is often more the routine than the exception.

4. You Will Make Decisions Based on Limited Information

As an ED physician, you won't have the luxury of time that your colleagues in other specialties do. Their diagnoses benefit from specific detail and the time needed to investigate more questions than emergency doctors.

You, on the other hand, will make life and death decisions based on limited information. In some cases, you may have to trust your intuition. Not everyone finds that idea acceptable, but you must if you’re going to succeed in emergency medicine.

5. You Will Need to Ensure Positive Patient Experiences

Because the ED is the hospital's front door, it becomes the place where patients and their families get their first impression — and it better be a good one because reimbursement is often tied to it.

According to Becker's, a negative experience in the ED will adversely affect a patient’s perception of all other aspects of the hospital. Recognizing this fact means you must do all you can to ensure patients have as positive an experience as possible given the serious nature of their condition.

(One-way emergency departments are addressing the need is by utilizing the AIDET framework, a mnemonic device designed to decrease the anxiety of patients and their families and improve patient satisfaction.)

Related resource: 10 Easy Ways to Improve Patient Satisfaction in the ED

6. You Will Learn to Navigate Murky Legal Waters

Every ED doctor-patient encounter is bound by an array of legal considerations, including professional liability, malpractice, risk management, CMS requirements, EMTALA, informed consent, treatment of minors, privacy, and many more. These murky legal waters can be challenging to navigate but must not be overlooked. (ACEP offers a series of legal resources, which can help).

7. You Will Recognize the Value of Community Participation

You are not just a member of the ED staff, but also of the community the hospital serves, which is why becoming involved in the community through advocacy, fundraising, and educational activities is vital.

As David Grace, MD, SFHM, senior medical officer at SCP remarked in a recent, article in The Hospitalist, community involvement leads to improved engagement, a better sense of belonging and job satisfaction, and enhanced relationships with key hospital and community stakeholders.

Community participation does not have to be time-consuming, either, as many activities require only a few hours a week.

(One good way to give back to the community is to take part in the EM Day of Service, a specialty-driven event where emergency care providers band together to identify and address community needs.)

8. You Will Work Irregular Shifts

As an emergency physician, expect to work three to five shifts per week, but not all at the same time. Depending on the hospital, you may work a 6 a.m. shift one day, start at 3 p.m. the next, and overnight the next.

This irregular schedule will play havoc on your biological clock, so compensate with plenty of sleep, exercise, and a proper diet.

9. You Will Learn to Deal with Death

Despite the many advances in healthcare, death in the ED is an all too common occurrence. Many patients coming into the ED are often critically ill with such severe trauma they can't be saved. Breaking the news to the family isn't easy, either, so in both cases, prepare yourself for the emotional toll it could take.

10. You Will Make a Difference

The difference ED providers make in the lives of patients and their families will be more noticeable than in just about any other department of the hospital. To take a traumatic patient, stabilize him, and know that your intervention (along with that of your fellow ED staff) played a role in saving a life — well, there are few things more fulfilling.

While not everyone will appreciate or even recognize the difference you made, you will know, and that is enough.

Becoming an emergency department physician is not for everyone. It entails working long hours and irregular shifts, getting comfortable with constant interruptions, ensuring patient satisfaction, navigating murky legal waters, dealing with death, and more.

But along the way, you will save lives, grow in your profession, earn respect, and make a real impact in your patients and community as well.

Coming out of residency can be exciting and intimidating. SCP’s Residency Resource Team helps new physicians, nurse practitioners, and physician assistants embrace this tradition. Learn more about the tools and services our Residency Resource Team has to offer.