Finished FM residency. Want to practice EM

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Itssalsatime

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Hi all, long time reader, first time poster.
My wife is wrapping up her 3rd year of family medicine at one of the top programs in the nation.
AOA honor society
Honors undergrad
271 step 1
272 step 2
She has all her certificates as well. ATLS, PALS, etc

After doing family medicine outpatient for 3 years she has come to find out how much she HATES it. Hates going in early and leaving late, hates answering inboxes on her days off, hates the slow environment etc.. she wants to do EM, especially after Moonlighting at several locations she loves it.
We also came to find out EM docs make $200~/hr....

What should we do? She wants to do EM. We have contacted several recruiters and found out she is able to work in rural environments, which have awful schools for our kids.

I see that there is an EM Fellowship that is accredited at the University of Tennessee Jackson, which after completion of one year and working one year full time you will be able to sit for the BCEM.
See here for confirmation:
Option #3:
http://www.abpsus.org/emergency-medicine-eligibility

we were to go that route, would she still be *shunned* out by EM hospital directors? Or would she still be able to work in a 100k patient annual facility?


I researched The Residency route and found out that it is nearly impossible to get into since the program would not be paid as much (since she completed family medicine).

It seems to me like the 1yr accredited EM fellowship @UT followed by 1 year practicing =BCEM would be her ticket?

Any suggestions and advice would be highly appreciated, my wife is currently doing 30 hour rotations in the hospital right now and we are both really stressed out and I actually arguing about what we should do. It is so difficult to find Clarity and all this and we both just feel like breaking down.. please help

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After doing family medicine outpatient for 3 years she has come to find out how much she HATES it. Hates going in early and leaving late, hates answering inboxes on her days off, hates the slow environment etc.. she wants to do EM, especially after Moonlighting at several locations she loves it.
We also came to find out EM docs make $200~/hr....

One thing that I think that your wife needs to figure out is if she really hates outpatient primary care or if she hates being a family medicine resident. Because yes, as a resident you spend a lot of time going in early and leaving late and covering your inboxes when you're not in the office - but that is not necessarily how it has to be once she is out in practice.

So, ask her - does she hate the type of medicine that she is learning or does she hate the circumstances of being a resident? Because that's a key difference. And keep in mind that while EM is "exciting" and "fast paced" it is not that way all the time - there is plenty of boring urgent care and social work issues that they see. Plus this means that she will definitely have to work nights, weekends, and holidays - something that she will not necessarily have to do once she is out in practice.

I researched The Residency route and found out that it is nearly impossible to get into since the program would not be paid as much (since she completed familymedicine).

Are there any private emergency medicine residency programs? That are outside the match process?

It is not impossible to complete a second residency - it does happen a lot of the time. However, it will be more difficult, just because there are a lot more people applying for residency slots now.

I don't think that you want to pursue a private EM residency program that is outside of the match - this means that it is not governed by the ACGME or the AOA. And that means that
a) they don't have to pay her a fair wage. Heck, they could make HER pay, just for the opportunity to work with them!
b) they can make her work crazy hours and no one will do anything to stop it
c) she still might not be board eligible afterwards.
 
First of all, THANK YOU for replying and taking your time to help.

I'm not sure how to qoute on my phone. Anyways, she is 100% certain she does not want to do Family Medicine. She has spoken to a lot of family medicine doctors this year and she'd decided she doesn't want to do it.

It seems that private residency is out of the picture, after reading your reply.

So going back to my original post I notice that there is a BCEM accredited program at University Tennessee Jackson and after completing that when you work in an emergency room for one year you are eligible to sit for the BCEM.

It seems to me that is the best route?
All, or most, of the job postings I see on practicelink.com say "BCEM".
So would that be our ticket?
 
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So going back to my original post I notice that there is a BCEM accredited program at University Tennessee Jackson and after completing that when you work in an emergency room for one year you are eligible to sit for the BCEM.

It seems to me that is the best route?
All, or most, of the job postings I see on practicelink.com say "BCEM".
So would that be our ticket?

No, I think you're getting confused between "BC EM" (= Board Certified EM) vs. "BCEM" (= Board Certification in Emergency Medication, which is a certification given by the ABPS). And this is not your fault - it is very confusing.

When places advertise that they only want BC EM (please note the space between the C and the E!), it is likely that they mean people who are board certified through the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine. The American Board of Emergency Medicine is part of the American Board of Medical Specialties (ABMS) - they are the main certifying body. Almost all hospitals and insurances recognize physicians certified through the ABEM/ABMS.

The BCEM that you are referring to, which your wife would get through the University of Tennessee program, is a certification given by the American Board of Physican Specialties. They are not as widely recognized, and it is very possible (I would say even likely) that some hospitals will still refuse to hire her, because the ABPS is not recognized as being "as good" as the ABMS. The only hospitals that will hire her would probably be in the boonies, which brings you back to your original problem with the bad schooling options for your kids.

Please see this EM thread for a better explanation: http://forums.studentdoctor.net/threads/bcem-abps-recognition-status.1109735/
 
I see.. now after looking back at those jobs they do same board-certified.. but then I see a lot of jobs thats a board-certified in Family Medicine with ED experience.

So would EM fellowship at UT followed up by 1 year ED then become BCEM, "count" as experience
 
Yea I mean I've always heard that to be in like the inner city, academic type ERs you'll need to do an actual residency. I will say that program thru Jackson is a good program and their ER is very busy. I know with that you could work in smaller, outlying areas, which I don't think is always the "boonies." For example Germantown, TN uses some FM docs in their ER (Methodist Germantown). That's hardly "the Boonies."
 
Yea I mean I've always heard that to be in like the inner city, academic type ERs you'll need to do an actual residency. I will say that program thru Jackson is a good program and their ER is very busy. I know with that you could work in smaller, outlying areas, which I don't think is always the "boonies." For example Germantown, TN uses some FM docs in their ER (Methodist Germantown). That's hardly "the Boonies."
Hey freeze,
Thanks a lot. My mom lives in Bartlett.
Did you attend the UT program? Frankly we are not interested in a big urban city like San Antonio or anything. There is an opening with EMcare in chattanooga ($225/hr) but the recruiter wrote us back saying that the required experience would be one year and 100k patient annually) whatever that means. I'm assuming at a facility that has that many annually.

We would love to live in chattanooga. Apparently it is a continuous need..

Our idea was to take the fellowship program at UT then reapply.
 
I see.. now after looking back at those jobs they do same board-certified.. but then I see a lot of jobs thats a board-certified in Family Medicine with ED experience.

So would EM fellowship at UT followed up by 1 year ED then become BCEM, "count" as experience

It probably would count, yes.

I am very hesitant to advise people to pursue an EM job, when not completing an EM residency. Regulations are becoming stricter, and not looser, and I would worry what might happen if the hospital were to change management - they could easily, very easily, kick out any EM physicians who did not complete an EM residency and are not board certified through the ABEM. Insurance companies are looking for any reason to deny payment, and refusing to pay a non-board certified physician is becoming more common.

If your wife is truly dead-set on EM, and not FM, I would encourage her to speak to the program director at her hospital (if there is one) and ask about completing a second residency. They may be willing to consider it, or at least give her some words of advice. If that fails, then go ahead and complete the UT fellowship program.
 
Bill, thanks for the thread link.
It seems to me that doing the fellowship and doing some extra training (that costs 1,500-3,00) would be the best bet? Then trying to get into an ED after?
This is all so confusing to me. Recruiters truly are not much help and medical directors qho do the hiring basically ignore our phone calls.
 
Bill, thanks for the thread link.
It seems to me that doing the fellowship and doing some extra training (that costs 1,500-3,00) would be the best bet? Then trying to get into an ED after?
This is all so confusing to me. Recruiters truly are not much help and medical directors qho do the hiring basically ignore our phone calls.

Don't waste your time talking to recruiters. They genuinely have no idea about how medicine is practiced in this country, and they are a basically just a high-end dating agency.

Medical directors will not even look at your wife's application. She's not EM certified and has very little EM training - why should they care? They don't have time for that kind of stuff.

Like I said, your wife should reach out to the EM program director at her hospital if there is one. If not, then she should reach out to the EM program where she did medical school. She needs more EM-specific guidance.
 
BCEM is not an equivalent to ABEM. When a job listing for an EM doc says BC/BE that means ABEM boards. ABEM boards cover the training of a 3-4 year EM residency. BCEM covers the training of a 1 year fellowship after a residency that includes at best 3 months of ED rotations. Employers target BCEM because they can't afford an ABEM doc, and don't have to hire an ABEM doc because they ship out their trauma. I'd be very concerned that a BCEM job is urgent care plus managing transport to trauma centers. Or, maybe that's what she likes about EM, and you just have to be more aggressive about finding locales that have good schools and smaller hospitals. You're grossly overgeneralizing to say that rural means one or the other. It's a big 'ol country.

If your wife isn't getting recruited, constantly, by professional headhunters who will bend over backwards to find her jobs that meet her wants and needs, then she's delusional about being at a "top" residency. A good recruiter is going to be able to interpret what she loves and hates about different clinical environments into the specifics of a job search. FM PGY3 is prom queen.

Also, assume your wife is burned out and depressed at this point, and is in no shape to have creative, imaginative ideas about what she needs to be happy. She's been beaten to a pulp at this point. She might not be in fighting shape for a while. In your shoes, I might prioritize finding communities you both want to live in, get your wife through residency and ABFM boards successfully, maybe spend a year or two doing sanity-preserving locums with lots of time off, budget accordingly, and then regroup on the big picture when she's rested and ready and you both have more info to work with.

General comment: It's really hard, imho, to have residency be your first real job, because then you don't have any perspective to see what's a residency pain-in-the-ass, and what's a primary care pain-in-the-ass, and what's a facility-specific pain-in-the-ass. If you're doing FM at a university program, you're probably not getting any insights into wild-type FM (which means "not fundamentally altered for the purpose of research"). During residency you don't have time to go find people with FM training who are doing jobs you want to do and have long meaningful conversations.

Tough position. Be kind to each other as much as you can.
 
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Thanks.
The recruiters we have spoken to are not headhunters, they are the recruiters for the company/hospital .. not the kind that bend over backwards.
I'm not one to brag, but I'll brag about my wife :) it is the top program. I'm not sure if it's wise to say which one it is or not, but i can PM you (if it even matters).

The time off idea is smart, to regroup.
I'llshow her this post when she gets home and maybe she'll want to reach out to the EM director. Wouldnit be wise to let her FM director know what she is up too, first? So as not to step on any toes?
 
General comment: It's really hard, imho, to have residency be your first real job, because then you don't have any perspective to see what's a residency pain-in-the-ass, and what's a primary care pain-in-the-ass, and what's a facility-specific pain-in-the-ass. If you're doing FM at a university program, you're probably not getting any insights into wild-type FM (which means "not fundamentally altered for the purpose of research"). During residency you don't have time to go find people with FM training who are doing jobs you want to do and have long meaningful conversations.

Tough position. Be kind to each other as much as you can.

Good advice.

I believe you when you say that your wife only wants to do EM, but Natividad makes a good point - she's tired, she's burned out, and she may not know what she really wants. There are a ton of good FM outpatient jobs that are great jobs - they pay decently, they have good work hours, they're in good locations, and she will be free on weekends, evenings, and holidays to spend time with her family and her hobbies.

If she's really distraught over the possibility that she may never place another central line, or that she will never have the chance to crack open another chest, then sure - go back and do additional EM training. If she's just upset because she's worried that, in FM, her life will forever suck and she'll be working non-stop, then she needs to realize that there are plenty of FM outpatient jobs out there that don't eat up your entire life. (I mean, hence, why I'm sitting at home in my pajamas, posting on SDN, not doing tasks or working on charts. :) )
 
Thanks.
The recruiters we have spoken to are not headhunters, they are the recru4in the company.. not the kind that bend over backwards.
I'm not one to brag, but I'll brag about my wife :) it is the top program. I'm not sure if it's wise to say which one it is or not, but i can PM you (if it even matters).

The time off idea is smart, to regroup.
I'llshow her this post when she gets home and maybe she'll want to reach out to the EM director. Wouldnit be wise to let her FM director know what she is up too, first? So as not to step on any toes?
'

You've PM'ed me the name of the program and you're right - it's a legit top program. :)

No, if she's a PGY-3, and is going to graduate in 8 months, she doesn't necessarily have to talk to her FM director first, right away. She is going to be graduating soon anyway, so she's not depriving the program of a resident. She will need his/her support eventually, if she does decide to apply for a second residency, but she doesn't have to tell her FM program director right away, while she is still weighing options.
 
She is more upset that she spokenwith several free-standing level II EDs that pay $225 an hour with a minimum 12 days per month. When she wrote down our current FM offer ($230k) next to $450k, she was highly disappointed with picking FM.
 
Thanks a lot we're both big on loyalty and would hate to step on toes.
 
She is more upset that she spokenwith several free-standing level II EDs that pay $225 an hour with a minimum 12 days per month. When she wrote down our current FM offer ($230k) next to $450k, she was highly disappointed with picking FM.

She needs to remember that some/many of those EM shifts will be overnight. Or weekends. Or on holidays. And if she didn't have a family and kids, then sure - no big deal. But after a while, as she already knows, it sucks, hard, to be away from your family when they don't have work/school, but you do.

If she is being offered $230K for a reasonable FM job, that is 8-5, few weekends, no holidays, and reasonable productivity expectations, in a good location, she should take it and run.

Also, $450K? How many shifts does she plan on working a month??
 
She needs to remember that some/many of those EM shifts will be overnight. Or weekends. Or on holidays. And if she didn't have a family and kids, then sure - no big deal. But after a while, as she already knows, it sucks, hard, to be away from your family when they don't have work/school, but you do.

If she is being offered $230K for a reasonable FM job, that is 8-5, few weekends, no holidays, and reasonable productivity expectations, in a good location, she should take it and run.

Also, $450K? How many shifts does she plan on working a month??

4 days a week 12 hour shifts at 225 an hour.
Mandatory 2 weekend days a month
She was offered 230k outpatient, but it isn't 8-5.. she spoke with a physician there and he more or less said it is 7:30-6pm. No calls. No Ob. 5 days a week.

Some of the places are 185 an hour 10 hour shifts 4 days a week.
 
She is more upset that she spokenwith several free-standing level II EDs that pay $225 an hour with a minimum 12 days per month. When she wrote down our current FM offer ($230k) next to $450k, she was highly disappointed with picking FM.

If money is her biggest hangup, then she needs to get into an EM residency. I am sure she would hate this, but $225 IC is considered low in most places.
 
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