About Emergency Medicine FAQs

EM physicians are considered the front-line in triage, evaluation, and stabilization of often critically-ill patients. Cornerstone traits of successful ER doctors are quick decision-making and appropriate action-taking, all while managing and working with a broad team of consultants, nurses, technicians, social workers, and respiratory therapists (among others). Physicians deal with a broad spectrum of adult and pediatric complaints and are expected to deliver patient-appropriate diagnosis, treatment, stabilization, and disposition of these complaints. While exact responsibilities may vary from system to system, they often include (but are not limited to):

• Resuscitation
• Airway management (intubation, ventilation, cricothyrotomy, tracheostomy)
• Cardiac resuscitation (cardioversion, defibrillation, pacing, central venous access, pericardiocentesis)
• Anesthesia (nerve blocks, procedural sedation, chemical restraint)
• Newborn delivery
• Orthopedic stabilization (splinting, dislocation/fracture reduction)
• Wound repair (suturing, abscess I&D, debridement, foreign body removal)

Residency in EM lasts either three or four years depending on the program. While curriculum specifics are unique to each program, typically, the bulk of the time is spent in the ED with additional off-service training in critical care, obstetrics, anesthesia, and IM. Elective time is also common, allowing residents to pursue interests in EM subspecialties/fellowships.

There are also combined programs with IM or pediatrics.

Find a full Emergency Medicine Programs List at the AAMC ERAS Directory.

Many emergency physicians have interests and/or training in some of the following subspecialties within EM:

• Toxicology
• Ultrasound
• Critical Care/Anesthesia
• EMS
• Wilderness medicine
• Sports medicine
• Pediatric EM
• Addiction medicine
• Undersea/Hyperbaric medicine
• Palliative/Pain medicine
• Hospital administration
• Medical education
• Research
• Telehealth/Innovation

Take a look at our faculty page to get in touch with some of our amazing faculty with experience in some of the above subspecialties.

Trauma levels refer to the acuity level of an ER (hospital) and can be a factor in deciding on residency programs. It is also important to remember that this only one indicator of what the acuity of an ED is like, particularly given that it does not explicitly spell out the responsibilities of the ED physician (for example, are they running the resuscitation or is trauma surgery) or patient volumes (for example, Level 2 center but with much more trauma activations than a Level 1). Here are the classifications from highest to lowest:

• Level 1: Any trauma. ED and Trauma Surgery teams 24/7. Consult services available include: orthopedics, plastic surgery, general surgery, neurosurgery, anesthesia, radiology, ICU, peds, oral/maxillofacial.
• Level 2: Most traumas. ED and Gen Surgery teams 24/7. Consult services include orthopedics, neurosurgery, anesthesia, radiology, ICU.
• Level 3: Some traumas. ED team 24/7 with general surgery teams on-call.
• Level 4: Some traumas. ED team 24/7 with transfer to higher-level trauma centers common.
• Level 5: Few traumas. ED teams 24/7 with most traumas transferred out.

You may learn more about trauma center levels from the American Trauma Society.

That is a tough question to answer. Traditionally, EM has been a mid-high level competitive specialty, often requiring a good mix of high STEP scores, extracurriculars including volunteering and research, and course grades along with good SLOEs. A good resource for up-to-date information is NRMP Match Data Reports.

However, given a recent increase in the number of EM residencies coupled with a decrease in the number of applicants, spots went unfilled in last year’s match. Thus, the landscape is potentially changing.

Because the answer to this question is always changing, talking to current EM faculty and residents is often the best option. 

Email us at emig@columbia.edu or reach us on Twitter!