Career Transitions for Emergency Physicians

Emergency medicine practice is defined by the clinical practice and activities of physicians 24/7/365. This day-to-day practice, chasing the proverbial chart rack and providing a safety net for the healthcare system is often equally rewarding and frustrating at times. A good perspective on the good being done for patients on their worst days can offset the challenges that lead to burnout or moral injury. The 24/7 demanding nature and shift work can also be a challenge for us as we proceed through careers in emergency medicine. If one reaches a time when a change from a full-time clinical role there are many options for emergency physicians.

The most obvious is intermixing clinical work with other roles. While some choose to decrease clinical hours without supplementing with other professional roles, there are options to share time between clinical hours and other roles in the hospital. These can include faculty roles and teaching. Involvement in student, resident and/or fellow education. Some of these roles can require additional training of varying degrees. This can range from courses, schooling, CME events, up to taking on a fellowship to become proficient and be a valuable resource to programs and trainees.

Administrative roles within the department or hospital can substitute for clinical work as well. These can be within department leadership, quality management, physician advisor/ utilization management or hospital administration. Some of these roles allow for joint clinical practice while others may lead to a decision to leave clinical practice. Health system roles including population health, utilization management and physician executive positions are increasingly common in health systems. There are many organizations, training programs and certifications that can be obtained to prepare or support development in these roles. Shadowing or taking on smaller administrative responsibilities while deciding on change can allow for clarity on what the roles require and the different type of cognitive load they can impart.

Often, maintaining clinical practice but in different roles and environments can reinvigorate practice. Telehealth positions have rapidly expanded in the post- COVID era. Benefits include the ability to continue standard emergency medicine practice while allowing for more time at home or even travel while providing these services. State regulations can vary both related to physician and patient location and often these services require licensing in multiple states. Splitting time between different emergency department environments can change perspective and allow for informed career decisions. Urgent care opportunities exist as shared or alternate career paths with lower acuity and allow for experiencing practice and patient case variety. The practice patterns in high vs lower acuity sites, trauma centers versus general emergency departments, travel work to different regions or working at facilities that staff observation units/programs are all ways to change the daily practice environment provide new opportunities and reinvigorate a physician’s career.

Consulting work is a regularly available option. Public and private sector roles exist. There are roles related to government agencies and review panels. These can include policy, professional conduct and licensing roles. Legal consultancy is a well-known field. Malpractice review for credibility and service as expert witnesses for cases is commonly performed by many physicians. Those pursuing these roles should be mindful of the precedent they can set and uphold the highest ethical standards. Medical practice consulting is a more targeted field using your experience and knowledge base to assist other practices and programs grow, develop and improve. These roles can be broad or specifically targeted (i.e.: patient experience, throughput, new service line development, quality improvement). Lastly, industry opportunities are often the most abundant. These can include medical device, research, pharmaceutical and product advising. Medical technology companies employee “super- users” to assist in product implantation and roll- out. Publications, both medical and general, have medical writer and editor roles for those strong in the written word. Consulting is not limited to the medical field but the knowledge and experience emergency physicians possess is valued in the business and finance fields offering guidance on investments, products or corporate healthcare.

A major field growing worldwide and rapidly entering the medical arena is related to technology and informatics. Specifically, the role of artificial intelligence in the practice of medicine. Artificial intelligence will lead to the most significant changes and likely greater changes, to medical practice since conversion to electronic medical records. In addition to many consulting opportunities that already exist for physicians with the breadth of knowledge about the healthcare system that exists in emergency medicine practice, there are numerous roles currently and growing in these information technology fields. Consulting roles and for those with the background technical expertise, development/design opportunities are available and expanding on a rapid timeline. In addition to industry opportunity related to artificial intelligence there will be plentiful opportunities for career development via research and incorporation of these technologies into the clinical environment.

Adjusting clinical workload and embracing alternate opportunities and experiences can reduce burnout and provide a new outlook for actively practicing emergency physicians regardless of career stage. Times of career experimentation or transition can allow for mental clarity and the opportunity to focus on physical wellbeing and personal pursuits. Many organizations and training programs exist to allow physicians to grow their knowledge base in preparation for alternate or coexisting career paths and ACEP has many educational opportunities, section and networking options to professionally develop. The breadth of emergency medicine practice and centrality in the health care system of emergency medicine allow emergency physicians to be uniquely positioned to take on many roles through the healthcare spectrum and beyond healthcare.