FM to ER

[NRAI2001]

Just wondering if anyone had any experiences with or know of people who worked in ER's after doing FM? Was also wondering if it would be difficult to join an EM residency after completing a FM residency? Would completing a FM residency (at a pretty well regarded program at a community hospital) give you advantage, disadvantage or neither when trying to do this?

Thank you

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[DeadCactus]

If you want to do EM, do an EM residency. Any delay or alternative routes are a gamble. If EM directly is not an option for you, then some rural ED's are still hiring FP's. A second residency is possible and a reasonable hope but not guaranteed, especially if you are not a strong applicant to begin with. There are some funding issues with a second residency which are frequently overstated. Some programs will look positively on previous training/experience and some will hold it against you.

 

[Alejandro]

Or you could consider Canada...they have an FM path for EM...though you'd have to jump through all of the credentialing hoops...

 

[kmb1908]

There are some FM programs that have an EM fellowship. It's only a year, and to my understanding, you are limited to working in Level 3 hospitals.

https://www.uthsc.edu/UTFamJac/erfellowship.php

https://nf.aafp.org/Directories/Fellowship/Search

 

[deleted547339]

There are some FM programs that have an EM fellowship. It's only a year, and to my understanding, you are limited to working in Level 3 hospitals.

https://www.uthsc.edu/UTFamJac/erfellowship.php

https://nf.aafp.org/Directories/Fellowship/Search

There's not a "Limit to level 3" persay. They're all non accredited fellowships so you will not be board eligible.

You can work anywhere someone will hire you.

As stated above, if you want to do EM, do EM.

 

[styphon]

There are combination FM/EM programs, and rural/suburban ER's may hire FM doctors depending on the area.

Why not just do EM?

 

[NRAI2001]

There are combination FM/EM programs, and rural/suburban ER's may hire FM doctors depending on the area.

Why not just do EM?

I matched into FM and I love FM. I discovered EM late in med school otherwise I would have probably applied to some FM/EM combined programs... but I think those programs tend to be very competitive? I was just wondering what options there are out there for FM? I have also heard that doing the EM-Fellowship after FM adds minimally to your ability to work in an ER. Might as well just make it 2 years try to find a PGY2 opening somewhere in EM and then be eligible to become board certified.

I was just talking to my friend who finished FM last year and is now working as a hospitalist. He also has a interest in EM and hes thinking about reapplying to EM or maybe looking for some openings where he can start as a PGY2... how viable of an option would this be?

 

[spitfire5454]

I am an FP who does EM. I have never done a day of FP in my life. I started moonlighting in pgy 2, loved it and never looked back. I went through the same thought process as you are. Unless you are lucky, you will be limited to large contract groups in outlying facilities. The only thing that will change that is an ED residency. A fellowship should be seen as an area for personal growth. I am the director of my ED, and I can tell you, an FP with a EM fellowship adds no marketable advantage (at least here). If I would hire you with it, I probably would have hired you without it. However, the fellowship will probably give you a year to increase your skill set. Make no mistake, the places you will probably work will be where you have no back up and have extremely high acuity. You can't call surgery or consult cards. It's ironically where the best doctors are actually needed. It can be done. I've seen good and bad ED docs from both FP and ED programs. The variability is much more prevelant from the FP side. It is a risky carreer path. It's risky to both your proffesional career and to your patients. Its up to you to figure out how much of that risk you are willing to take and act accordingly

 

[NRAI2001]

What about an FM doc starting as a pgy2 in an EM residency somewhere? Difficult? Moderately difficult to do?

 

[SansaStarkMD]

I always hear that it's difficult for FP's to work in ED's, that they're getting pushed out, etc.

What about FP's currently working in ER's? Anyone ever heard of a FP getting fired from a long term regular gig for not being boarded?

 

[Promethean]

I always hear that it's difficult for FP's to work in ED's, that they're getting pushed out, etc.

What about FP's currently working in ER's? Anyone ever heard of a FP getting fired from a long term regular gig for not being boarded?

Is that a thing? I mean, if there aren't other issues at play?

If you are a reliable member of a team, in good standing, and with adequate clinical skills, would you get pushed out of an existing gig for not being board eligible for EM? That just seems absurd to me. Why drop a decent known quantity to need to fill a spot with someone else who may have any number of issues?

Now, if they have other deficiencies, then sure, whatever pretext you need to shift the staff, right?

I know nothing. I'm just commenting with my thoughts because I don't want to miss the answer to this question.

 

[deleted480308]

Is that a thing? I mean, if there aren't other issues at play?

If you are a reliable member of a team, in good standing, and with adequate clinical skills, would you get pushed out of an existing gig for not being board eligible for EM? That just seems absurd to me. Why drop a decent known quantity to need to fill a spot with someone else who may have any number of issues?

Now, if they have other deficiencies, then sure, whatever pretext you need to shift the staff, right?

I know nothing. I'm just commenting with my thoughts because I don't want to miss the answer to this question.

if the hospital goes academic and you can' serve as the resident supervisor it might be a reason

 

[Apollyon]

That happened at my residency program as they were gearing up for the first class. They called it "Black Thursday" (or, maybe, I got the day wrong). All the FMs, bar one, got let go. The one who was left was grandfathered in to EM.

 

[throckmortonDO]

Currently, there seems to be a good amount of jobs for IM/FP boarded docs for low volume ED's, and the offerings I have seen have mostly been through CMG's, as there is a need for EM docs nearly everywhere. Also, as an FP boarded physician your salary will be quite low, even though you are doing EM work compared to EM boarded folks. It is what it is. I have a friend who is FP boarded, he started a small 'group' with a few friends, they round on nursing homes, own an urgent care center, and occasionally pick up shifts in single coverage ED's. He does pretty well for himself. Anecdotal of course, but there doesn't seem to be a paucity of options, at least at this point in time.

 

[Pisiform]

I have seen a good number of FPs working in ED. I personally know one FP in midwest who did not do any fellowships is now working at a fairly decent ED with 70,000 visit every year. She is making 225/hr. And the location is not middle of no where either, an hour from big metro city

 

[deleted109597]

In many places, FP can work in any ED. Doesn't mean the should. It's a tough place to learn on the job. That being said, the explosion of FSEDs combined with the supply shortage of BCEM docs has meant that many of the FSEDs are staffed by FP docs, at least around me. And in some places, the FSEDs are the only place with BCEM docs, but the main hospitals are full of IM/FP/whatevers.
But yeah, there's always a chance you may lose your job, if it's in a bigger city or a new CMO starts. But that's true for any of us, so I wouldn't fret. I would prefer every ED be staffed by boarded docs, but that's impossible.

 

[deleted547339]

I always hear that it's difficult for FP's to work in ED's, that they're getting pushed out, etc.

What about FP's currently working in ER's? Anyone ever heard of a FP getting fired from a long term regular gig for not being boarded?

Yes. A hospital where I rotated during med school did this. They slowly pushed out all non-EM boarded folks over the course of a few months so they could advertise that everyone on staff was EM trained.

 

[carbonizedeyesockets]

Is that a thing? I mean, if there aren't other issues at play?

If you are a reliable member of a team, in good standing, and with adequate clinical skills, would you get pushed out of an existing gig for not being board eligible for EM? That just seems absurd to me. Why drop a decent known quantity to need to fill a spot with someone else who may have any number of issues?

Now, if they have other deficiencies, then sure, whatever pretext you need to shift the staff, right?

I know nothing. I'm just commenting with my thoughts because I don't want to miss the answer to this question.

I know of a hospital that hired a new medical director and one of her first courses of action was to fire every doc that was not boarded in EM. She hired a bunch of BE/BC EM docs to work PRN while she worked on hiring fulltime staff. Not common-place, but it happens.