THE WORK OF THE AMERICAN EMERGENCY PHYSICIAN

The organisation of the American emergency health care system has chan ged rapidly during recent years, but it remains very different to the system in the United Kingdom. American emergency departments are organ ised around an attending physician based service, rather than a consul tant led service. As a result, the work of the American emergency phys ician differs considerably from that of the United Kingdom A&E consult ant. The problems associated with working in an attending physician ba sed service include antisocial hours of work, sleep deprivation, decre ased job satisfaction, and ((burn out,)) all in the context of a relat ively hostile medicolegal climate. Although there appear to be no easy answers to some of these problems, the A&E specialist should be aware of the potential future difficulties for A&E medicine as it develops within the United Kingdom.