"Combined training is a clear advantage for students who are contemplating a career in family medicine in rural areas where they also may be the sole provider of emergency care services." I don't really understand this. Could you explain what you think it means?

It's basically making the arguement that if you are planning on being the only doc in town somewhere you will be the only guy providing emergency medicine care. You should be more comfortable and knowledgable in dealing with trauma in that town if you have combined training in Emergency Medicine.

Some people would make the arguement that you could just do EM and have a rural primary care practice, but in reality EM doesn't really train you for that. Just like FM doesn't really train you as well as EM for trauma.

It's a matter of what you want to make of your career and if it is worth the extra years of training to you to get double boarded.

I interviewed at this program. Simply, it says that you will be highly qualified to care for anyone, both acutely and chronically. It is great for working in small town america, especially in under served areas, or internationally, where you might need to intubate someone or place a chest tube or care for someone with HIV related diseases chronically.

"Combined training is a clear advantage for students who are contemplating a career in family medicine in rural areas where they also may be the sole provider of emergency care services." I don't really understand this. Could you explain what you think it means?


Agree with the above. I was just skiing out in Jackson Hole, WY and the clinic there is run by a guy who's double cert in EM and FM. If it matters to you, he cleans up financially. But more importantly, I think, he gets the satisfaction of being the "country doc" for a whole lot of people (gets way more respect than an urban PCP would get) AND he provides life-saving emergency services for stupid/arrogant/hardcore skiers. Also, if he feels like taking an extra vacation and needs some extra cash, he can just moonlight in the ER for a night shift and get a nice hefty lump sum.

FP/EM sounds like a good option.

But...

1) There used to be EM fellowships for FP residents. I think the last one closed a few years ago in Tennessee. It makes me wonder why Christiana decided to start one. Then again, there used to be other EM/IM programs that closed (eg, Northwestern), and while some EM/IM's are old, most started in the '90s.

2) EM/IM is a good alternative. You get the option to do subspecialty fellowships afterwards (if you can handle extending your training after 5 years!), and there is a good track record for going into academics. CC is a popular option, too, which many places are trying to implement. I also think that IM training is culturally different from FP.

3) Another alternative are the bad a** FP programs out there. You know, unopposed residencies with lots of surgical experience, eg Martinez and Ventura. If you want to be the rural doc who can handle anything, I think these are the places to look at.

4) Then again, you can't beat moonlighting to pay for a trip...although it seems that the more rural you get, the less likelihood that you need to be BC/BE in EM to work in the ED.

what is the length of the EM/FM dual residency?

what is the length of the EM/FM dual residency?

most are 5 years.....

Could you practice both EM and then IM while not on shift? If so, how would the schedule be like?

Could you practice both EM and then IM while not on shift? If so, how would the schedule be like?

I split my time between EM and IM, 75% time working in an academic ED and 25% time as supervising staff on the inpatient general medicine rounding team. I never do both together, i.e. when I am on a 2-week block of IM rounding I am off the ED schedule.

My colleagues have made similar arrangements, really you have to negotiate with the two departments to figure out exactly what you can do, it's usually done on a case-by-case basis.

FP/EM sounds like a good option.

But...

1) There used to be EM fellowships for FP residents. I think the last one closed a few years ago in Tennessee. It makes me wonder why Christiana decided to start one. Then again, there used to be other EM/IM programs that closed (eg, Northwestern), and while some EM/IM's are old, most started in the '90s.

2) EM/IM is a good alternative. You get the option to do subspecialty fellowships afterwards (if you can handle extending your training after 5 years!), and there is a good track record for going into academics. CC is a popular option, too, which many places are trying to implement. I also think that IM training is culturally different from FP.

3) Another alternative are the bad a** FP programs out there. You know, unopposed residencies with lots of surgical experience, eg Martinez and Ventura. If you want to be the rural doc who can handle anything, I think these are the places to look at.

4) Then again, you can't beat moonlighting to pay for a trip...although it seems that the more rural you get, the less likelihood that you need to be BC/BE in EM to work in the ED.

1) I interviewed at Christiana last year. Great PD there. Super enthusiastic and approachable. She is working to create some innovate systems solutions through new delivery models that will keep people out of the ED that don't need to be there without violating EMTALA. if this is something you are interested in, you will be in very very good hands. The EM program has a fantastic reputation as well.

2) The EM/IM/CC tract is something that places have been taking about for sometime, but few have been able to pull the trigger. U Pitt has had one approved for nearly 2 years now and still not made it official.

3) no comment
4) The concept that you don't need to be BC/BE in EM in rural areas will not be the case in the next 5-10 years. EM residencies are growing rapidly. Urgent Care might be more of an option that an actual ED if you are not BE/BC in EM.