Most of our graduates apply to a Canadian Emergency Department for work after completing their EM year. Here are a few considerations when making the plunge to work in a real ED. Keep in mind these ten questions to ask every department that seeks to hire you….

1. Are you applying to a tertiary care centre, a busy community hospital or a less busy/low acuity department? Each requires a specific skill set from being able to manage the sickest of patients to being able to work under the pressure of being alone with minimal supports. Have you asked the prospective department what their acuity is, what the volumes are and whether the department type is in keeping with what you are looking for?  Make sure the practice type suits your desired interest.
2. Are you interested in academic work? This includes having residents or medical students and conducting research. University affiliation may be needed to the closest university. If this is what you want, does your department allow or enable such a career pathway? And does it affect how many shifts you do if you are academically involved? In some departments there are financial incentives as well for such activity, while others see themselves as non-academic and may not compensate or even enable such a career pathway. It is worth exploring in advance and being prepared for what you need to do to be academically involved or not.
3. Is the ED fee for service or under an AFA agreement? If it is FFS, ask how the flow systems would facilitate such a compensatory scheme and if it is under AFA, ask about the specifics. Find out whether it is an open AFA (all new recruits join) or a closed AFA (key associates run the AFA and other recruits are paid as contracted staff). Ask about any compensation available for non-AFA work (WSIB, ward calls, out of province patients, OB calls, in hospital cardiac arrest etc).
4. Is there a graduated call system? Most departments will allow new recruits to work only select shifts with certain mentors while they get their “feet wet”. They might also allow a few weeks with time off guaranteed to ease the transition to full time practice. This is important as many other things might be happening to a physician starting practice (marriage, kids, buying a house, college registration etc) along with the anxiety of the job starting out. Any allowances or flexibility when you are first starting out and a mentorship program are both useful
5. Is there a scheduling system? How are shifts distributed? Do people have a choice of weekends? Is there a decent ability to trade shifts? How far in advance is the schedule made? make sure the scheduling system is one that will work for you. Some departments do try to schedule new graduates for less desirable shifts. Consider it an initiation. Other departments do not. It is better to now ahead of time if their scheduling parameters work for you.
6. Do you work anywhere else (or plan to do any other work)? This is an important question because some departments schedule in a way that assumes people will not work anywhere else and do not have flexibility with another department’s schedule. This could be a challenge if you plan to work elsewehere. It is better to let all the potential recruiters know that you plan not to be at one site only and that you do wish to work in a few different places. It is better to be honest and disclose your interests so that they know and can advise accordingly. Clearly if a department has a minimum shift requirement for you to work there, it would be good to ask as it may interfere with the ability to work elsewhere.
7. Are the logistics tenable? How long are the shifts? Some people do not like shifts longer than 8 hours and some departments that are less busy or have low acuity can have 24 hour shifts! Make sure you look into the shift configuration. Make sure also that there is a good handover policy. Some community hospitals allow their day MD to show up when there are patients to be seen which makes handover hard for the night MD. Stress that you like to work where best practices for patient safety have been implemented so that they can see you as an innovator.
8. Growth beyond shiftwork? Ask about opportunities for your own development in the department. Is there an area of interest you can pick up within the department? perhaps you can be the CME coordinator or the POCUS leader or the patient safety champion in that department. Every department has something they can change for the better. Share your experiences from wherever else you have worked to build your own department.
9. Coverage for illness or emergencies? Try to find out if they have policy in case of illness or family emergency because this can happen to anyone at any time. Ask for examples where a staff member had something happen within that department and how they dealt with it.
10. Ask for the names of physicians newly recruited to the department and ask to meet with them for coffee to explore some of these issues with a new grad or a new hire. Most departments will be happy to find you a like minded partner to help you get recruited there. if there is hesitation about this, then that is a definite red flag