Medical Toxicology

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Hello docs,

I am applying the next coming cycle to med schools and, lately, I have developed an interest in Emergency Medicine, and Toxicology. Below are few questions I would like to get answers for:

1. Do EM Toxicology-trained physicians practice in regular ED's, or do they only work at poison centers, the CDC and other government agencies?

2. Is there a preference for 4-year residency trained physicians over the 3-year trained ones when it comes to do the fellowship?

3. Are medical toxicologists compensated more? (despite my interest in medical toxicology, I would greatly dislike to spend two extra years in training and not being financially rewarded).

Thank you and forgive my naivety.

1. They can practice in regular ED, they can be on call for their group for tox related issues, they can run a toxicology clinic, they can be affiliated with poison centers.
2. There may be a preference for 4 year programs but not a make-break issue. This is also program dependent.
3. Compensation is not necessarily any more. As a toxicologist, you make less actually.

Originally Posted by Ibn Alnafis MD

Hello docs,

I am applying the next coming cycle to med schools and, lately, I have developed an interest in Emergency Medicine, and Toxicology. Below are few questions I would like to get answers for:

1. Do EM Toxicology-trained physicians practice in regular ED's, or do they only work at poison centers, the CDC and other government agencies?

2. Is there a preference for 4-year residency trained physicians over the 3-year trained ones when it comes to do the fellowship?

3. Are medical toxicologists compensated more? (despite my interest in medical toxicology, I would greatly dislike to spend two extra years in training and not being financially rewarded).

Thank you and forgive my naivety.

1) the short answer is yes to all the options - it depends on what you want to do with your training. Some of us practice in EDs and do tox on the side, others do Med Tox 100% of the time and don't practice in the ED. It's very individualized.

2) No real preference; a 4-year program is designed primarily to get you into academia, but so is a 3-year program followed by a 2 year fellowship. So, if you want to be in academia, it doesn't really matter. But, as PP said above, this is training-program specific.

3) I disagree with PP that we "make less actually." I believe PP's response is based on the fact that most tox people are in academia, which traditionally does pay less than community-based EM. That being said: I have dedicated nonclinical time to do research/teach, I'm not a slave to moving meat, and I will have a longer career compared to others... I'm trading up-front dollars for long-term benefits & success. Plus, having this niche allows me to enjoy my career more... and happy docs are typically better docs.

Check out the ACMT (American College of Medical Toxicology) at www.acmt.net for any other information; you can ask questions & learn what it is we actually do (which is quite a lot, actually).

Just my $0.02,
-t

We have a tox fellowship and we are a 3 year program. The number one reason the fellows quote for going into it is because 20 years down the line they can "retire" from the ED and work exclusively as Tox attendings, which is significantly easier. From my conversations with them, they will definitely not make more than regular ED attendings, but as Daiphon said there are other benefits.

But, won't their "Toxicology" knowledge become rusty or outdated after 20 years of practicing EM?

Originally Posted by Ibn Alnafis MD

But, won't their "Toxicology" knowledge become rusty or outdated after 20 years of practicing EM?

Well no because they will work as both Tox and ED attendings throughout their careers. One of them plans to do 3 ED shifts per week and 2 Toxicology calls per week. It sounds busy because you have to round on those patients that you admit during your toxicology call.

Hello docs,

I am applying the next coming cycle to med schools and, lately, I have developed an interest in Emergency Medicine, and Toxicology. Below are few questions I would like to get answers for:

1. Do EM Toxicology-trained physicians practice in regular ED's, or do they only work at poison centers, the CDC and other government agencies?

Most Tox trained EPs are working in the ED, however that is certainly not true for all. There are 100% clinical tox jobs out (such as Pinnacle Health), however it can be very difficult to support yourself doing 100% clinical tox..

2. Is there a preference for 4-year residency trained physicians over the 3-year trained ones when it comes to do the fellowship?

In general, no, however fellowship programs associated with a 4 year EM residency will (part of the requirement of the fellowship is an opportunity to work the in primary specialty).

3. Are medical toxicologists compensated more? (despite my interest in medical toxicology, I would greatly dislike to spend two extra years in training and not being financially rewarded).

No, but it can be. In general, the overall time-pay relationship is lower. However for those people who work in industry, do legal work, other consulting, etc, there is significant earning potential.

EM is paid relatively well as a specialty. I can easily see 2.5 patients per hour in the ED. I don't have the opportunity to see, in consultation or follow up, more than 5-10 patient as a day (and usually it is 3-6 ). Some consults can be very involved and take an hour or more.

However, Tox can open doors and those doors can have money behind them. My committee appointments, academic salary and my clinical hours reduction are directly related to having a tox board. I get paid for all that other stuff (including the committee stuff).

Basically the bottom line is that do tox if that's what makes you happy or if it interests you. Don't do it for the money.

There is money to be made in terms of what the attendings have commented on (above).

And believe me when I say that these tox people are usually all smiles. I have yet to meet a tox attending who is unhappy at an academic institution.

I have met 1 who was not happy at a community institution, however.

Thank you all for your thoughtful responses.