Are you considering a career in emergency medicine? With so many specialties to choose from, it’s one of the hardest choices medical students have to make.
This guide will cover the pros and cons of becoming an emergency medicine physician, from the exciting variety and shift work flexibility to the high burnout rates and routine presentations that dominate your daily practice.
There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in residency, whether or not you want to focus on procedures, the level of patient interaction you’ll have, the setting you’ll practice in, the people you’ll work with, your work-life balance, your compensation, and more.
This series delves into the career of an emergency medicine physician from the perspective of Dr. Kevin Jubbal. He outlines the factors he considered and explains why he ultimately chose not to pursue emergency medicine as his specialty. That said, rest assured that this guide presents both sides of the story, outlining the pros and cons of pursuing a career in emergency medicine.
For a completely objective and unbiased look at emergency medicine, including more details into the daily life of an emergency medicine physician and the exact steps to take to become one, also check out our guide to How to Become an Emergency Medicine Doctor (So You Want to Be).
What I Liked About Emergency Medicine
1| Variety
One of the most exciting aspects of emergency medicine is that you never know what will come through those doors. Each shift brings a completely unique day, keeping you constantly challenged and growing as a physician.
The variety is genuinely thrilling. One room has a patient experiencing a myocardial infarction, the next presents with altered mental status, another is a trauma case, and someone else is vomiting blood. You’re constantly on your toes, managing diverse pathologies and life-threatening situations. If you’re someone who doesn’t want to do the same thing forever and thrives on being challenged, emergency medicine delivers exactly that experience.
The fast pace, the excitement, and the genuine opportunity to save lives create an adrenaline-fueled environment that many physicians find incredibly rewarding.
2 | Lots of Doing
Internal medicine delves deeply into conversations about disease processes and intellectual exploration, and surgery focuses on fixing a limited range of pathologies with meticulous technique—but emergency medicine stands apart on its own.
Emergency medicine requires quick thinking, comfort with high-acuity situations such as codes and traumas, and an affinity for efficient, practical procedures. You’ll perform ultrasounds, place central lines, suture lacerations, insert chest tubes, and much more. You’re accomplishing a tremendous amount in a short period of time with little room for slowing down—which is perfect if you enjoy a fast-paced environment.
And mercifully, there’s no rounding. Thank god.
The pace is also significantly faster than internal medicine, which involves considerable waiting for test results, lab work, and imaging studies. It’s the classic “hurry up and wait” mentality. Emergency medicine, by contrast, is about making decisions quickly and executing them efficiently before moving to the next patient. For impatient personalities, this approach is incredibly satisfying.
3 | Easy Disposition
“Dispo” refers to disposition—where you send a patient when your role is complete. On services like internal medicine, patients can remain admitted for days or even weeks simply because of difficulties discharging them to the appropriate level of care, whether that’s a nursing facility or elsewhere. It’s one of the more frustrating aspects of healthcare bureaucracy.
In emergency medicine, you don’t deal with that headache. You generally decide to admit the patient, at which point they become the admitting service’s responsibility, or you discharge them. Occasionally, you’ll transfer patients to outside hospitals, but the disposition process is straightforward and final.
4 | Shift Work
Emergency medicine operates on shift work, meaning you clock in, clock out, and you’re done. You don’t take work home with you, which provides a clear boundary between your professional and personal life.
You can also craft a more flexible schedule based on your preferences. While you won’t have ideal scheduling control during residency, as an attending physician, you gain significantly more autonomy over your hours.
That said, shift work becomes more challenging as you age, since you can’t completely escape the occasional night shift or holiday coverage. But the trade-off of not having a pager and maintaining work-life separation is substantial.
5 | People and Vibe
Emergency medicine attracts exceptionally laid-back, fun people who remember that life is meant to be enjoyed, not just endured through work. While surgical specialties often felt like work defined your entire identity, emergency medicine maintains a rushed energy but with a lighter tone—as in we should enjoy every moment and not lose sight of the bigger picture.
I found that refreshing.
6 | Shorter Residency
Emergency medicine residency can be completed in either 3 or 4 years, which may not seem significant until you’re actually living it. The difference between 3 years and 6 years during your late twenties to early thirties is enormous—both in terms of quality of life and financial implications.
A shorter residency also means you can start earning an attending salary sooner and begin paying back student loans more aggressively. Emergency medicine attending salaries are respectable, making this financial advantage even more meaningful.
7 | Undifferentiated Patients
In medical school, you’re trained to approach patients knowing nothing beyond a chief complaint. Most other specialties receive patients with preexisting diagnoses and referrals already in place.
Emergency medicine maintains that fundamental diagnostic challenge—working with undifferentiated patients and determining the underlying pathology from scratch. For physicians who enjoy medical detective work, this is an intellectually stimulating experience.
What I Didn’t Like About Emergency Medicine
1 | Bread and Butter Cases
The routine cases in emergency medicine simply weren’t my passion. The majority of presentations involve abdominal pain and chest pain—lots and lots of both. While you’ll occasionally see something more noteworthy and exciting, it often feels like managing 80% monotonous presentations for 20% thrilling cases.
I can’t sustain myself on that ratio. I need 80% enjoyment or fulfillment with 20% monotony, not the other way around.
Here’s a telling example: when I saw a laceration come through the ED, I was genuinely excited to repair it. The emergency medicine residents were happy to hand it off to me, and I took great pride in spending time creating the best closure possible. It was a win-win-win situation—I practiced my suturing skills, the patient received excellent care, and the EM resident could focus on other tasks they preferred.
But that enthusiasm for lacerations definitely made me out of place in emergency medicine.
2 | Emergency Department Misuse
I won’t delve into the political or social issues surrounding this topic, but the reality is that emergency departments are frequently used in ways they weren’t designed for. This isn’t necessarily the patients’ fault; it’s more a function of our broken healthcare system, but it remains frustrating for emergency medicine physicians.
You’ll encounter uninsured patients or undocumented immigrants using the ED as their primary care source rather than for urgent medical conditions. Homeless patients sometimes feign medical complaints to secure shelter. Drug-seeking patients can become aggressive, angry, and even violent in their attempts to obtain medications. These situations drain resources and create challenging working conditions.
3 | Too Fast-Paced
That laceration example highlights another issue—emergency medicine’s pace is extremely fast and rushed. While I enjoy occasional bursts of excitement, I also value being meticulous with my work.
This isn’t to say emergency medicine physicians aren’t detail-oriented or careful, but there’s inherent pressure to see as many patients as possible, which can compromise other considerations.
As the first provider assessing undifferentiated patients, you’ll occasionally make mistakes. The differential diagnosis for something as simple as arm pain is incredibly broad. It could be a heart attack, cancer, spinal cord compression, infection, or numerous other possibilities.
Because your role involves quickly assessing, stabilizing, and referring patients, you’re statistically more likely to miss diagnoses compared to specialists who have more time and focused expertise. Emergency medicine physicians often receive criticism from other specialists for management decisions or missed diagnoses. Some people don’t mind this uncertainty and diagnostic imprecision, but it doesn’t align with my personality.
4 | Limited Procedural Complexity
I knew I loved procedures, but I didn’t realize how much the type of procedure mattered to me. Emergency medicine procedures are fast and deliver immediate results, which is satisfying. However, they’re generally more straightforward and less technically complex than surgical procedures.
For someone who finds fulfillment in intricate, challenging technical work, emergency medicine procedures didn’t provide the depth I was seeking.
5 | Felt Like a Job
Ultimately, during my pediatric and adult emergency medicine rotations, I felt like I was going to a job—clocking in and out, working my hours as a means to pay bills. I didn’t find myself entering states of flow or becoming completely engrossed in the work as frequently as I did in other specialties.
Emergency medicine has one of the highest burnout rates among all medical specialties, and I knew if I entered the field, I would likely become part of that statistic. Every specialty has elements you won’t love, but I believe it’s crucial to find a specialty that makes you feel alive and energized at least some of the time.
If You’re Considering Emergency Medicine
So, should you become an emergency medicine physician?
The answer isn’t straightforward—it requires honest self-reflection about your personality, work style preferences, and tolerance for uncertainty.
Emergency medicine isn’t for everyone, and that’s perfectly fine. The real question is whether the reality of this specialty matches your expectations and values. Can you find fulfillment in the routine cases that make up the majority of your shifts? Does the unpredictability energize you or exhaust you? Are you willing to sacrifice procedural depth for breadth and variety?
If you thrive on variety and unpredictability, enjoy quick decision-making and procedural interventions, want clear work-life boundaries through shift work, appreciate managing undifferentiated patients, and find fulfillment in fast-paced environments where you’re constantly challenged, emergency medicine could be an excellent fit.
However, you must be prepared for the reality that most presentations will be routine rather than exciting. The emergency department is frequently misused in ways that create frustration. The fast pace may compromise the level of meticulousness you prefer, and the specialty has one of the highest burnout rates in medicine.
Emergency medicine attracts physicians who genuinely enjoy the adrenaline and variety of acute care. Some physicians are strongly drawn to the immediate problem-solving and diverse pathology, while others appreciate the flexibility and work-life balance that shift work provides. If you’re considering emergency medicine, make sure you experience multiple rotations to understand whether the routine cases feel sustainable alongside the exciting ones.
Emergency medicine is an excellent specialty for those who embrace uncertainty, possess quick decision-making skills, and aren’t deterred by the emotional demands of high-acuity care. The field’s flexibility through shift work and shorter residency allows you to maintain a better work-life balance compared to many other specialties.
If you want to learn more about emergency medicine, check out So You Want to Be an Emergency Medicine Doctor.
