Emergency medicine

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Download transcript [1]

Associate Specialist in Emergency Medicine, Dr Meng Aw Yong talks about his working life as part of the team at Hillingdon Hospital Accident and Emergency Department. He gives his personal insight into a career in Emergency Medicine and is clearly passionate about the work. (This video lasts 3 mins)

Nature of the work

They see patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders.

They treat conditions such as:

• loss of consciousness, eg from an injury to the head, drug poisoning, an epileptic fit
• severe bleeding
• damage to the brain or other major organs, due to trauma
• cardiac arrest [2] (when the pumping action of the heart stops)
• breathing difficulties
• broken bones
• mental health problems, eg self-harm patients

“There is constant variety and challenge: exposure to a great deal of “real life” ". Jonathan Benger is a professor of Emergency Medicine in Bristol.

Read Jonathan’s story [3]

Common procedures/interventions

These include:

• defibrillation (using a defibrillator to apply an electric shock to the heart to get the heart working normally again)
• endotracheal intubation (insertion of a tube through the nose or mouth into the windpipe, for example, to get oxygen to the patient’s lungs)
• tracheostomy (an opening is made in the windpipe from the front of the neck, for example, to get oxygen to the patient’s lungs)

The aim is to maximise patients’ chances of survival and a good recovery.

Sub-specialties

Many emergency doctors develop sub-specialty interests in:

• paediatric emergency medicine
• pre-hospital emergency medicine

Some doctors choose dual accreditation with intensive care [4] medicine which leads to a CCT [5] in both specialties.

Want to learn more?

Find out more about:

• the working life [6] of someone in emergency medicine
• the entry requirements [7] and training and development [8]
• a first-hand account of life in emergency medicine [3]

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.

  Find out more about the current pay scales for doctors [9], and there's more information on the BMA website [10]. 

  NHS employers [11] provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in emergency medicine, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training [12] (CCT [5]) or CESR-CP. You will receive your CCT [5]/CSER-CP at the end of your emergency medicine training.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
  • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training [13] programme director. This role will be working within the LETB/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

  SAS doctor roles

  SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.

  Find out more about the SAS doctor role [14].

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Academic pathways

  If you have trained on an academic emergency medicine pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in emergency medicine. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

   Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [15]

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine [16].

  The Clinical Research Network [17](CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  There are opportunities to be employed by the NHS, academic institutions, private sector, universities, the armed forces, organisations and national governing bodies.

  You can specialise further in paediatric emergency medicine, pre-hospital emergency medicine, sports medicine, critical care or academic emergency medicine.

  Some emergency doctors have portfolio careers where they combine clinical work with activities such as volunteering, medical journalism, management, teaching and international work.

  BASICS [18] is a charity which trains and organises volunteers in different roles (including immediate care doctors) to provide medical help at the site of an accident or other medical emergency, or in transit. Volunteers include doctors, nurses, paramedics, military medics and medical students.

• Job market and vacancies

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  This page provides useful information about the availability of jobs, finding vacancies and where to find out more.

  Job market information

  In 2016 the competition ratio [19] for CT1/ST1 Emergency Medicine was 2.21,and for ST3 was 2.37 and ST4 was 0.76 (NHS specialty training, 2016).  [20]

  The number of doctors completing CCT [5] training has averaged about 150 a year from 2009-2013. Emergency medicine typically has the eighth or ninth highest numbers completing training each year among the GMC’s 65 specialties.

  The demand for accident and emergency treatment is high (over 21 million attendances per year) and emergency medicine is an expanding specialty. There are about 1,586 full-time equivalent consultants and 1,903 medical registrars in England (NHS Digital,2016 [21]). Female staff make up 29% of the consultant workforce.

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data [22]

  NHS Wales medical and dental workforce data [23]

  Department of Health, Social Services and Public Safety workforce information for Northern Ireland [24]

  Where to look for vacancies

  Health Education East of England is the lead local education and training board (LETBs) for pre-hospital emergency medicine (PHEM) training. All candidates apply through the online application system Oriel.

  The A&E Agency is a specialist recruitment consultancy [25] for locum and permanent posts in emergency medicine.

  All jobs will be advertised on NHS Jobs [26].

• Further information

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  Royal College of Physicians [27]

  Royal College of Physicians of Edinburgh [28]

  Royal College of Physicians and Surgeons of Glasgow [29]

  The Royal College of Emergency Medicine [30]

  The Intercollegiate Board for Training in Pre-hospital Emergency Medicine (IBTPHEM) [31]

  Emergency Medicine Trainees Association [32]

  The Heart of England Foundation Trust’s Emergency Department [33]

  The Faculty of Intensive Care Medicine [34]

  British Association for Immediate Care (BASICS) [18]

  European Society for Emergency Medicine (EuSEM) [35]

  International Federation for Emergency Medicine (IFEM) [36]

  Association of Paediatric Emergency Medicine (APEM) [37]

  Faculty of Pre-hospital Care, The Royal College of Surgeons of Edinburgh [38]

  The Society for Acute Medicine (SAM) [39]

  Heartlands ED [40]