FM in the ER?

Our group (in a university hospital) has a number of FM-trained docs that work in the ED (including all areas, and single covered at outside hospitals). They are credentialed by the hospital system to work in the areas where they do.

Some of them are great. Others make me cringe every time I have to take a sign out.

People that state blanket-wise that busy EDs won't hire FM people don't have all the information.

I just counted - there are 21 docs out of 58 that are either FM, IM, or Peds (not Peds EM) that work in the group.

Apollyon said:

Our group (in a university hospital) has a number of FM-trained docs that work in the ED (including all areas, and single covered at outside hospitals). They are credentialed by the hospital system to work in the areas where they do.

Some of them are great. Others make me cringe every time I have to take a sign out.

People that state blanket-wise that busy EDs won't hire FM people don't have all the information.

I just counted - there are 21 docs out of 58 that are either FM, IM, or Peds (not Peds EM) that work in the group.

Click to expand...

Can IM doc still work in an ED nowadays?

The physician's group in the ED that I used to work at was made up entirely of IM trained docs. Apparently some of them were EM boarded because they were grandfathered in. A couple of years ago, the hospital demanded that all the ER docs were EM residency trained, and the group lost the contract.

Is there any way for and IM or FP trained doc to get boarded now?

howelljolly said:

Is there any way for and IM or FP trained doc to get boarded now?

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Sure. It's called EM residency.

Take care,
Jeff

Jeff698 said:

Sure. It's called EM residency.

Take care,
Jeff

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thats what I thought.

Apollyon said:

Our group (in a university hospital) has a number of FM-trained docs that work in the ED (including all areas, and single covered at outside hospitals). They are credentialed by the hospital system to work in the areas where they do.

Some of them are great. Others make me cringe every time I have to take a sign out.

People that state blanket-wise that busy EDs won't hire FM people don't have all the information.

I just counted - there are 21 docs out of 58 that are either FM, IM, or Peds (not Peds EM) that work in the group.

Click to expand...

ok. i do use the blanket statement alot -- about EDs not hiring FM people...
so i want to ask a couple questions to clarify --

are these physicians (FM, IM ones) grandfathered into emergency medicine?

have these physicians been around for a long time (i.e. retaining their position) or were they recently hired?

finally, do you have an EM residency -- if so, does the RRC care that 1/3 of the docs are not residency trained?

Apollyon said:

Our group (in a university hospital) has a number of FM-trained docs that work in the ED (including all areas, and single covered at outside hospitals). They are credentialed by the hospital system to work in the areas where they do.

Some of them are great. Others make me cringe every time I have to take a sign out.

People that state blanket-wise that busy EDs won't hire FM people don't have all the information.

I just counted - there are 21 docs out of 58 that are either FM, IM, or Peds (not Peds EM) that work in the group.

Click to expand...

I think that it is safe to say that you will be at a significant disadvantage as a FM trying to work in the ED. Most of the emergency departments in my city if not all of them now require ED trained doctors to staff the ED. A lot of this has to do with liability and with insurance payments. I have heard that there are places that do hire FM docs to work the ED but I think this is a shrinking area. I would say if one really wants to work in the ED and wants to try and get in the back door with a FM residency they will have a lot of obstacles and doors closed on them. I imagine this only getting worse in the future.

I would also expect the number of FM/IM people to go down as more and more people head to PA school. Many of the people on here suggest that they can work in the fast track section of the ED as FM/IM, but more and more I've seen those spots being filled by PAs.

I'm sure there are places where there are exceptions, but I don't think it's fair for someone to plan on going into FM and then finding an ED job.

howelljolly said:

Can IM doc still work in an ED nowadays?

The physician's group in the ED that I used to work at was made up entirely of IM trained docs. Apparently some of them were EM boarded because they were grandfathered in. A couple of years ago, the hospital demanded that all the ER docs were EM residency trained, and the group lost the contract.

Click to expand...

I did not count the "grandfathered in" people, as they are EM-boarded.

jazz said:

ok. i do use the blanket statement alot -- about EDs not hiring FM people...
so i want to ask a couple questions to clarify --

are these physicians (FM, IM ones) grandfathered into emergency medicine?

have these physicians been around for a long time (i.e. retaining their position) or were they recently hired?

finally, do you have an EM residency -- if so, does the RRC care that 1/3 of the docs are not residency trained?

Click to expand...

Only a few are grandfathered in, but the hospital system requires board certification in the field in which one was trained. As the practice track closed in 1992, the physicians left are few.

Mix of long-time and new hires.

Don't have an EM-residency, but, if you look at the RRC requirements, they only require the core faculty to be EM-boarded/prepared. They would NOT care.

I tend to agree that the more prevalent thing these days is what jbar and elcapeeetan refer to...
NP/PA covered fast track/urgent care within the main ER.
ER boarded/trained physicians in the main ER....

it would bother me to be practicing EM alongside non EM boarded physicians. EM is a legitimate specialty and to say that an IM trained physician can work in the ER seems to minimize our field as a specialty.... we could never work as a cardiologist, even though we float pacers, cardiovert unstable patients, treat chf, and read hundreds of ekg's per month... as such a cardiologist should not work in the ER since s/he would also have to take care of the traumas, strokes, dislocations, vaginal bleeders, etc...

The problem is that we are not training enough ED physicians to make up for the number of shifts that need to be covered. I honestly believe, that we will never have enough ED trained docs and will have continue to hope that other specialities are able to pick up the shifts....do they make the best ED physicians...NO...but they beat the heck out of the alternative which is no care at all. Just in the area, I'm from, you would have to shut down close to 15-20 ED's because they would not be able to staff them, if you relied only on ED trained docs.

Our multihospital EM group only hires boarded or EM residency prepared docs. In fact, there are only two hospitals in our system which will even allow non-EM trained/boarded docs.

edinOH said:

Our multihospital EM group only hires boarded or EM residency prepared docs. In fact, there are only two hospitals in our system which will even allow non-EM trained/boarded docs.

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A lot of this depends on what part of the country you live in. The South has fewer EM residencies per capita than say the midwest. ACEP's Report Card that came out had a great stat on number of residency spots per 100,000 population. The South lags pretty far behind in general on this, so we still have a lot of unprepared/untrained EM physicians in the work force.

Last week, while moonlighting in a rural Alabama ED I relieved a retired PEDIATRICIAN. That one just really blew my mind. This wasn't an incredibly slow rural ED either. I've had shifts there seeing 2 to 2.5 pt/hr for 24 hrs straight with some occasional high acuity.

I'm a town in south Arkansas with a city population of about 23,000. The ED there receives all of the locals and transfers from about three cities of 10,000 people. When I was in paramedic school, rotating thru there, the ED was staffed entirely by FM trained physicians and the nearby FM residency.