Emergency Medicine Fellowship for Family Physician

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

doc sam

Full Member
10+ Year Member
15+ Year Member
Joined
Feb 9, 2008
Messages
11
Reaction score
0
Hi folks,

I realize this topic may have been discussed before, but I didn't find much when I searched.

I'm currently in practice in family medicine. I like it okay, but I'm starting to feel a little burn-out. The chronic stuff is getting a bit old. The low pay is getting a bit old. The always on call, little time off is getting a bit old.

When I was in school, I strongly considered going into emergency medicine (as well as a couple other specialties) but ended up choosing a family med residency instead for various reasons. I was never really sure I had made the right choice however and those doubts are starting to grow.

I've considered trying to go do a second residency, but I'm married and I'm getting a bit old. Plus, I don't really understand the whole residency funding thing, but every time I try to investigate this, there are always comments basically saying that doing a second residency is difficult because the programs won't get funded by medicare or something along those lines. Bottom line my grades, USMLE stuff, etc were pretty good, and I have little doubt I could've matched in Emerg. Med as a student, but now as a practicing Fam. Med doc, I'm not so sure how likely it is I could get into an EM residency.

I know a lot of ER's are already staffed by FP's and I've had job offers, but to be honest, it's not where my training was focused. I don't want to get in over my head and hurt anyone through my own incompetence.

So, when I look at the American Academy of Family Physicians website directory of fellowships, I see there are several one and two year "unofficial" fellowships in emergency medicine. A couple of these are with the University of Tennessee and a few are at private hospitals and run by Emergency Medicine physician groups.

I wanted to get a feel from some of you folks who are in this specialty. Do you think it would be worth my time exploring this option? Pros? Cons?

Feedback appreciated!

Thanks,

Sam
Members don't see this ad.
 
There are 1 year fellowships in Canada that FPs can do in order to work in the busier urban ERs. I know most of them still feel grossly unprepared to manage an ER independently, but after 5-10 years out in practice they usually feel as competent as their 5 year EM trained counterparts. They get to bill the same, anyhow. As for your situation, I'm sure it it all depends on how long you've been out in private practice, what kind of acute care experience you've had in the meantime, etc. If you just graduated from your 3 year FM residency, had lots of EM + ICU exposure and then went on to do the fellowship, it would be a lot different than if you've been in a clinic and haven't managed a really sick patient in 15 years. I'm just a med student, so this is only based off what I've heard from friends who went through the route that you're considering.
 
2/5 physicians that work in my group are family practice trained. In the near future, in the rural communities, there is a shortage of board certified ER docs. I think a fellowship would help you get a job in those areas.

I'm sure there are numerous residencies that would love to take a crack at a seasoned FP doctor as long as you seem teachable (If it is obvious that you are going to be second guessing every decision that your attending makes, they will be reluctant). Lets be honest, you are going to have more knowledge on certain subjects than the majority of your attendings. There will be innumerable experiences where you have to swallow your pride and keep the, "This attending is an idiot, they are totally mismanaging this patient." comments inside.

Considering that a huge percentage of ER patients are more urgent care- type visits, you are going to out-shine your fellow residents and attendings consistently on most patients (urgent care and primary care topics are brushed over lightly in ER residencies, and the majority of effort and learning is focused on true emergencies and interventions).
 
Members don't see this ad :)
so what are the odds of getting an ER position in the city. Also what about the fast track side of the ER. Also if one gets a job in an ER group will they make the same money as an ExR physician.
 
Howard7 said:
so what are the odds of getting an ER position in the city.
Click to expand...

Which city? New York City? Close to 0/infinity. Rapid City (the one in South Dakota) probably reasonable. (100-10000/infinity). Cities in the middle? In the middle.

If you want to work in the ED, do an EM residency. If you want to work in the clinic, do FM or IM.
 
Start by getting some airway experience. Running a code is fairly straightforward which is why we have acls, atls, pals etc for people to freshen up. Learn a few pressers and learn how to do central lines. Then start w locums. They always need ER docs.
 
gutonc said:
Which city? New York City? Close to 0/infinity. Rapid City (the one in South Dakota) probably reasonable. (100-10000/infinity). Cities in the middle? In the middle.

If you want to work in the ED, do an EM residency. If you want to work in the clinic, do FM or IM.
Click to expand...

I'm going to go against the party line here.

To the OP: it's part of our job security as EM-trained physicians to insist on our path as the True, Correct, and Only Path. And yes, ideally it is. But life is not ideal and the fact is that there are not nearly enough EM-trained doctors to get around (which is why we are in such demand and highly paid).

Although the EM-fellowship concept threatens our job security, what does that matter to you? The reality is that extra training like that will give you a leg up when applying for positions against FM-trained folks without it. And there are *plenty* of jobs out there for you. You can even live in a big city so long as you are willing to drive 30-60 minutes outside of it to work.

I live in a big city (like New York City), and even *I* could not easily find (nor did I desire) a job inside the city itself (although admittedly I did not try very hard since I live on the outskirts of the city, due to my preference to avoid inner city life).

In your specific situation, the EM-fellowship seems to make sense, based on what you've told us. Yes, you won't be officially EM-board certified but you will have a leg up on other FM-trained docs working in the ER. Shrug.
 
  • Like
Reactions: 1 users
Are there Osteopathic ER fellowships like there are Allopathic ER fellowships for family docs? I'm curious because all I see are 11 programs on the aafp website.
 
The ideal is to suck it up and go back to residency for a full 3 years. This is going to give you the most marketable skill set and highest job security. The funding thing is largely an non-issue, an inaccurate rumor propagated by people who don't understand how funding for residency works.

A fellowship will give you a leg-up compared to other non-EM boarded applicants but ultimately you will be left with the jobs that EM boarded physician's don't want. I think a 1 year fellowship is a reasonable compromise but if you're going to do a 2 year fellowship I would argue you might as well do a residency.
 
DeadCactus said:
The ideal is to suck it up and go back to residency for a full 3 years. This is going to give you the most marketable skill set and highest job security. The funding thing is largely an non-issue, an inaccurate rumor propagated by people who don't understand how funding for residency works.

A fellowship will give you a leg-up compared to other non-EM boarded applicants but ultimately you will be left with the jobs that EM boarded physician's don't want. I think a 1 year fellowship is a reasonable compromise but if you're going to do a 2 year fellowship I would argue you might as well do a residency.
Click to expand...

I was wondering if I could get your thoughts on the notion that applicants that have already gotten a residency in something other than EM are unlikely to get one because "reasons". The only things I've heard are claims along the lines of how you "can't teach an old dog new tricks". As you can tell I'm not very convinced lol but I was wondering if there's any truth to this and maybe there actually is a good reason for not taking on an FM trained doctor for an EM residency. Thanks so much! I'm asking as someone who's leaning towards FM but I'm not sure yet.
 
I think this is a good option for you. If you're going to do EM in a rural ED where they hire FPs, you'll be better at it if you do the fellowship than you would without it.
 
Dredge said:
I was wondering if I could get your thoughts on the notion that applicants that have already gotten a residency in something other than EM are unlikely to get one because "reasons". The only things I've heard are claims along the lines of how you "can't teach an old dog new tricks". As you can tell I'm not very convinced lol but I was wondering if there's any truth to this and maybe there actually is a good reason for not taking on an FM trained doctor for an EM residency. Thanks so much! I'm asking as someone who's leaning towards FM but I'm not sure yet.
Click to expand...

Maybe my program is an outlier but every class seems to have a person or two who either started or completed another residency. Most people seem to view it as a positive as long as you're desire to do EM is convincing. They're usually strong interns because they've already learned to be a doctor even if they don't know the specifics of the specialty. It's also nice to get their perspective on issues they've seen from a different angle.
 
DeadCactus said:
Maybe my program is an outlier but every class seems to have a person or two who either started or completed another residency. Most people seem to view it as a positive as long as you're desire to do EM is convincing. They're usually strong interns because they've already learned to be a doctor even if they don't know the specifics of the specialty. It's also nice to get their perspective on issues they've seen from a different angle.
Click to expand...
Agree. In the past several years, we've taken ex-ortho, ex-plastics, and a fully trained FM attending. Several peds, gen surg, and internist too over the years, and even poached a psych resident.

The biggest "reason" is frequently the funding issue, and sometimes a visa issue. This will lock you out of some programs, but not all; and those programs ought be upfront & straight with you - just ask.

-d

Semper Brunneis Pallium
 
DeadCactus said:
Maybe my program is an outlier but every class seems to have a person or two who either started or completed another residency. Most people seem to view it as a positive as long as you're desire to do EM is convincing. They're usually strong interns because they've already learned to be a doctor even if they don't know the specifics of the specialty. It's also nice to get their perspective on issues they've seen from a different angle.
Click to expand...

Daiphon said:
Agree. In the past several years, we've taken ex-ortho, ex-plastics, and a fully trained FM attending. Several peds, gen surg, and internist too over the years, and even poached a psych resident.

The biggest "reason" is frequently the funding issue, and sometimes a visa issue. This will lock you out of some programs, but not all; and those programs ought be upfront & straight with you - just ask.

-d

Semper Brunneis Pallium
Click to expand...
Thanks so much for the advice guys!
 
  • Like
Reactions: 1 user
You must log in or register to reply here.
Next unread thread

Similar threads

F
Strongly Considering Going Back to Fellowship for Sports Medicine
Replies
11
Views
981
GatorCHOMPions
G
G
Emergency Medicine Shows Rebound in 2024 Residency Match - ACEP Now
Replies
23
Views
2K
AlbinoHawk DO
AlbinoHawk DO
han14tra
Calling off sick in Emergency Medicine
Replies
23
Views
2K
xaelia
xaelia
alphaholic06
Emergency Physician Group Seeks to Unionize
Replies
14
Views
2K
Rekt
Rekt
lucid_interval
Best ultrasound fellowships at the moment?
2
Replies
88
Views
5K
BoardingDoc
BoardingDoc
Top