Passion drives students to choose emergency medicine

BY DIANE DUNGEY

The man came to the University of Chicago Medicine Emergency Department because his wife insisted he seek care for his chronic sore throat. But he didn’t want to discuss his symptoms and balked at having any diagnostic procedures. He seemed on the verge of walking out.

Steering the conversation to the root of the patient’s reservations revealed a disdain for the healthcare system born in part out of unpleasant personal experiences, said Timothy Shen, MS4, who was doing a clerkship in emergency medicine.

“ The students who are choosing emergency medicine love the type of medicine that we practice. I believe that the students here at the University of Chicago are drawn to the opportunities to enact change and have an impact on the community that they serve.”

Keme Carter, MD Emergency Medicine Clerkship Director

“We were able to work past that and he became more amenable to getting a workup. It ended up that he did have a small tear in his esophagus that could have become a lot worse very quickly,” Shen said.

Rather than being frustrated by the patient, Shen appreciated the insight into the man’s point of view and the opportunity to help build trust. The experience ended up affirming his decision to specialize in emergency medicine.

Shen is one of seven University of Chicago Pritzker School of Medicine students who matched into emergency medicine this year a path chosen despite the challenges exposed by the pandemic and well-publicized reports of a discouraging job outlook for new emergency medicine physicians.

Shen is drawn to the chance to be part of a team that’s the “face” of healthcare for patients who might arrive in the ED with many medical and social needs and experiences. And he and other fourth-year students say they were attracted to the field by Pritzker’s emphasis on healthcare equity and support for the community.

“Emergency medicine is the most unfiltered way to care for the underserved, in my opinion, so it has a very obvious draw for me,” said Ngozi Nwabueze, MS4. “When I found out what emergency medicine was about in my third year, it was like a lightbulb went on. I thought, ‘Why doesn’t everybody do this?’”

‘The sky is not falling’

The COVID-19 pandemic bookended the medical school careers of 2023 Pritzker graduates. The initial wave of infections struck during their first year, and hospitalizations in Illinois repeatedly peaked through the next two winters before leveling off. ED staff were in the trenches.

At the same time, signs began to emerge of a strained job outlook for emergency physicians nationally. The American College of Emergency Physicians (ACEP) in 2021 projected there could be a surplus of 7,845 emergency physicians in 2030. A September 2022 update cited practicing emergency physicians’ eroding confidence in job and income stability.

So, it wouldn’t be surprising if these circumstances discouraged some medical students from going into emergency medicine and that might be what’s happening on the national stage.

While the number of emergency medicine residency positions continues to grow, the number of annual applicants dropped by 25% between 2021 and 2023, reports the Electronic Residency Application Service, or ERAS. The specialty had 555 initially unfilled positions in the 2023 Match, more than double the previous year.

Pritzker’s experience has been more encouraging. Emergency medicine remains one of the top choices for 2023 graduates tied for fourth-most popular specialty this year and the number seeking residencies has remained fairly stable over at least the past eight years.

Keme Carter, MD, Associate Professor of Medicine and Emergency Medicine Clerkship Director, said many considerations go into students’ selection of emergency medicine, but Pritzker has offered them something different.

“Our students have been exposed to a training environment that is really unique, that does serve as a safety net of a community where the faculty and the residents are doing really interesting and impactful work. They see a vision for themselves within our specialty,” said Carter, who also is Associate Dean for Admissions and Associate Vice Chair for Diversity, Equity and Inclusion Education in the Department of Medicine.

“They know that there is still opportunity within emergency medicine, that the sky is not falling,” she said.

Coming from Pritzker would put students in good stead in any job market, attending physicians told Jessica Guillaume, MS4, during her ED rotations at UChicago Medicine and elsewhere.

“I feel really fortunate being at the University of Chicago. A lot of people told me the fact that you’re here for medical school is probably a sign that you’ll train somewhere that’s well-respected, and you’ll probably be well-positioned to be competitive when it comes to applying for jobs,” Guillaume said.

Nwabueze said neither the workforce projection nor the pandemic were major factors as she weighed devoting her career to emergency medicine.

“I’ve never really thought of that as something that would draw me out of wanting to do the specialty,” Nwabueze said of the jobs report. “I’m aware of it. But the pros, for me, so much outweigh the negatives.”

As for COVID-19, “I had to kind of defend emergency medicine as my choice to my mom, for example, who definitely didn’t want me to do anything close to this pandemic or another one that could happen. But I trust the ability for the healthcare field to arm itself against incoming threats and incoming viruses,” she said. “I hope that whenever the next threat comes we will be a little bit more prepared after having gone through this.”

A model of emergency care

Guillaume envisions a career in rural emergency medicine, but she’ll build off the model of wraparound care learned in UChicago Medicine’s busy urban ED and Level 1 adult trauma center.

Patients arrive needing medical aid and sometimes much more. The ED team embraces a holistic approach from the first question “How can I help?” to services as varied as the Feed1st food pantry, the Violence Recovery Program and connections to community resources.

“How can we also connect you with more stable housing or connect you with resources for food? That’s the part of emergency medicine that really appealed to me,” Guillaume said.

“We do our patients a disservice if we’re only looking at their medical needs, because their ability to pick up their medications or go to appointments or keep their wounds clean are all directly tied to their ability to access transportation and medical supplies that they need at home and clean running water and electricity,” she said.

Guillaume met with Carter in her third year after reflecting on what she liked most in each of her clinical rotations.

“I did a trauma surgery rotation and really liked the fast-paced Emergency Department portions of that. I loved the breadth of internal medicine. In pediatrics, I enjoyed navigating family discussions. And in OB-GYN, I really liked the procedural aspects.”

“ I try to encourage the students that if you think this is right for you, then we will help you find your voice. You tell us what a perfect career looks like, and if emergency medicine is the type of medicine you want to practice to get there, then we can show you a path.”

Abdullah Pratt, MD’16 Assistant Professor of Medicine

“I told Dr. Carter I think that points me to emergency medicine,” said Guillaume, who did an emergency medicine rotation on the border of Navajo lands in New Mexico and hopes to work in the Indian Health Service.

Students considering emergency medicine weigh their tolerance for the unpredictable, for being a generalist with a wide breadth of knowledge and experience, for very unfiltered and sometimes heart-wrenching interactions with patients and their families, and for working rotating shifts, Carter said.

They consider the allure of a specialty that leaves room for academics, research, medical leadership or community activism, with Pritzker offering role models of how those interests can be met, Carter said.

She points to Abdullah Pratt, MD’16, as an example. A native of the South Side, the emergency physician’s community activism includes organizing to push for creation of the UChicago Medicine Level 1 adult trauma center, starting a violence prevention initiative and founding a program that has taught thousands of teens how to respond to medical emergencies. The teens become a resource for the community and gain exposure to medical careers.

“There are so many varied, diverse and interesting ways that you can be a practicing emergency physician and still invest in work outside of the ED to have a substantive impact on patient well-being and the education of trainees,” Carter said.

Pratt credits Carter, Christine Babcock, MD, Director of the Emergency Medicine Residency Program at UChicago Medicine, and others for building a program that emphasizes diversity and commitment to addressing social and medical inequities. But they don’t sugarcoat, he said.

“Emergency medicine attracts those people who say, ‘I’m going to fight for something,’ and we’re telling the honest truth that when you fight for something, it’s actually a fight,” Pratt said.

As a result, students going into emergency medicine are confident of their choice, he said. “They know exactly what they’re signing up for and are more committed to doing it,” Pratt said.

The students say the sense of shared mission makes the Emergency Department a special place to work.

Shen, who initially saw himself as an orthopedic surgeon, loved the ED’s camaraderie, energy and teamwork.

“I feel like emergency medicine physicians are some of the coolest people. People are just fun and very unique individuals,” he said.

Shen had enjoyed his third-year orthopedics rotation, but a piece of advice stayed with him.

“The advice that I got was, don’t do ortho if it’s something that you just enjoyed while you were there; do it if you couldn’t see yourself being happy if you never went back in the operating room. That didn’t really resonate with me.

“But when I went into the Emergency Department and had my first patients that I was able to talk to and help work up, I felt like I would not be fulfilled if I didn’t have the chance to work in that capacity again.”