How easy is it to return to clinical practice after time off?

[holabuster]

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I'm considering entering a 2-year non-EM public health fellowship (e.g. Epidemic Intelligence Service at the CDC) after EM residency, since I want to be the leader of a department of health long-term. However, I still love working in the ED and want to continue it part-time after the fellowship.

How easy is it to return to clinical EM practice after time off? What is the longest break you've had, and what was it like to return? Would it be easier if I spent a few years as an attending before doing the fellowship, so I have more experience under my belt?

 

[gutonc]

(Caveat: I'm not in EM)
Why not do locums during the fellowship to keep your skills up?

Regardless of the field, taking 2 years completely off of clinical medicine will make returning to it difficult (both personally and from the perspective of people wanting to hire you down the road). This is even more of an issue in procedural fields (which EM obviously is).

 

[Angry Birds]

I'm considering entering a 2-year non-EM public health fellowship (e.g. Epidemic Intelligence Service at the CDC) after EM residency, since I want to be the leader of a department of health long-term. However, I still love working in the ED and want to continue it part-time after the fellowship.

How easy is it to return to clinical EM practice after time off? What is the longest break you've had, and what was it like to return? Would it be easier if I spent a few years as an attending before doing the fellowship, so I have more experience under my belt?

This is the worst idea ever. As a brand-new attending, if you take a gap year(s), your clinical career is over. Forever.

It's also a bad idea because your job security and salary are so much higher for EM than public health. For your long-term career, you should aim to do both EM & public health, at least 50/50. If you happen to obtain wild success with public health, then you can wind your EM practice down organically. But, do NOT bank on it. The bird in your hand is worth way more at this point in time, and that bird is EM.

You should continue to work during your fellowship. Maybe you can do 24 hour shifts so that you only work a few days a month. BUT, you must work at least a shift or two per week, or else your clinical skills will die.

I've done something similar by the way, although I don't want to reveal too much publicly so as to preserve some anonymity. Like you I also had underestimated my EM, and now I realize that EM is what will always keep me afloat, no matter what.

I think a realistic (and great) goal would be to aim for an academic clinician sort of job at an academic medical center (AMC), with your home department being EM, but your scholarly activity revolving around public health (and try to get as much protected time as you can get).

 

[Janders]

The beauty of EM... you can find a job drivable that you can get AT LEAST 1 shift a week in as locums.

Personally I would tell you that you need 6 shifts /mo MINIMUM to keep from eroding skills as a newbie, but if your fellowship is truly 5-days a week that might be hard. Maybe they'll work with you on scheduling to allow some extra clinical time....

 

[Vandalia]

A couple of different but related issues:

First, it is possible to return to full time clinical practice after a significant gap. I know a number of military officers who had primarily administrative duties for decades who returned to full time clinical practice on retirement without missing a beat. In particular one AF brigadier general went back to being a general surgeon with a pretty high volume practice upon retirement. He had been doing primarily administration for 20+ years with the occasional operation every once in a while to keep his skills somewhat up, and from what I have heard he was back up to full speed very quickly. So it can be done - and is done fairly often.

The primary issue is with credentialing. Again, for the military officers I speak of it was easier in their last couple months of active duty to make sure they had the number of procedures needed for their post-retirement job. That can be much more of an issue if you are in a non-clinical fellowship. The other difference is that it is a heck of a lot easier to "get back on the bicycle" after a gap if you have spent 15 years practicing every day, as opposed to the gap taking place just after you become minimally competent immediately after residency.

As a general rule, "skills atrophy" does not refer to difficulty in performing a procedure, rather to performing a procedure quickly. There are of course the exceptions that prove the rule.

There is also the issue that was previously raised as to finding a job. Again, a one year gap becomes far less significant after a decade of post-residency experience, as opposed to a one year gap after 0/1 year of practice. As far as employment goes, it can also be difficult to have the connects/job leads/references to get a job back in EM after a gap. Again, this is why the person who does EM for a number of years first has an advantage.

 

[holabuster]

Thank you so much for weighing in. I completely agree that I want to maintain my EM skills so I can always have a livelihood. I'm waiting to hear back from people who have done the Epidemic Intelligence Service to see how much they were able to moonlight (one person said maybe 2 shifts a month...).

I'm definitely considering being an academic clinician, but I've become very disillusioned with a lot of research. It just seems like a lot of this work, maybe particularly in public health, never has any real world impact. This is one of the main reasons I wanted to get directly involved with a public health department, so the analyses I enjoy doing will make a difference in the real world.

I agree this is kind of a gamble, so I appreciate all of your insights.

 

[holabuster]

This is great information. I'm starting to think that if I want to continue working in EM (either part-time with public health work or full-time after leaving public health work), I should work maybe 5 years straight out of residency.

On the other hand, I wonder if taking the leap to do EIS straight out of residency, so that I know definitively whether I want to work in public health departments, may be better. If not, I'd just do whatever it takes to rebuild my skills. Would save me from having to do 5 years of post-residency work during which time if I'm not doing academic work, I may become a less competitive applicant for EIS.

 

[deleted480308]

I'm considering entering a 2-year non-EM public health fellowship (e.g. Epidemic Intelligence Service at the CDC) after EM residency, since I want to be the leader of a department of health long-term. However, I still love working in the ED and want to continue it part-time after the fellowship.

How easy is it to return to clinical EM practice after time off? What is the longest break you've had, and what was it like to return? Would it be easier if I spent a few years as an attending before doing the fellowship, so I have more experience under my belt?

do an MPH on the side while working at least half time....you can weigh your options after

 

[emergentmd]

This is great information. I'm starting to think that if I want to continue working in EM (either part-time with public health work or full-time after leaving public health work), I should work maybe 5 years straight out of residency.

On the other hand, I wonder if taking the leap to do EIS straight out of residency, so that I know definitively whether I want to work in public health departments, may be better. If not, I'd just do whatever it takes to rebuild my skills. Would save me from having to do 5 years of post-residency work during which time if I'm not doing academic work, I may become a less competitive applicant for EIS.

All you need is to cover the Gap Year. Its not that difficult. There are locums EVERYWHERE that even Pays alot off $$$$.

Do your fellowship, get credentialed at locums place. When you have a break during fellowship, do as much shift as you like and bank. But atleast there is no GAP. Your file will show that you were credentialed at Hospital Locums and there is not Gap. No one will ask you how many shifts you worked, how many hours you have, etc.

That is the easiest way, least time consuming path. You can go 3 months without doing a shift, the locums don't care. When you have a week off or nice 3-4 dy break, pick up 2-4 shifts.

 

[holabuster]

Interesting ideas guys. Will definitely consider both. I did half of an MPH through a research job I did before med school and found that what I'm looking for is experiential learning/direct work instead of schooling, but doing an MPH right after residency while working half-time could still be helpful.

Emergentmd, you're saying that as long as I am credentialed with a hospital for locums for the 2 years of the EIS fellowship (and do shifts to maintain skills), I would be able to get a job practicing EM afterward?

 

[deleted547339]

Why are you not just doing a fellowship???? There are fellowships specifically designed for things like this where you work 8-10 shifts a month and they'll float you on whatever your academic interest is (e.g. admin/MBA, research, public health, US, international health, etc). The nice thing is that just about any program can do this as you'll be bringing more to them as a service than you'll be getting from them (i.e. if they pay you 80-120k/y and cover a degree or teach you a skill, you'll still be creating more revenue for the department than they are paying you). Pick a few places you want to go and email a copy of your CV and your letter of intent to their chair or head of division you're interested asking if you can build a fellowship.

As above, the beauty of EM is that it's easy to do part time. It's not like CT or nsgy where it takes up your life.

 

[emergentmd]

Interesting ideas guys. Will definitely consider both. I did half of an MPH through a research job I did before med school and found that what I'm looking for is experiential learning/direct work instead of schooling, but doing an MPH right after residency while working half-time could still be helpful.

Emergentmd, you're saying that as long as I am credentialed with a hospital for locums for the 2 years of the EIS fellowship (and do shifts to maintain skills), I would be able to get a job practicing EM afterward?

Absolutely. Your Credentials packet would look just like anyone else who worked locums for 2 yrs. They don't ask how many hours you worked. All you need is 3 peer references which you can get with some docs that works in the Locums.

Work 1-2 dys a month locums and you are golden. Skip a few months if you want.

 

[holabuster]

Awesome, emergentmd, this takes a lot of pressure off. I'd still work really hard to try to do 2-3 shifts/month to maintain skills, but good to know that in terms of job hunting, it won't shut me out.

TimesNewRoman, I've found very few EM fellowships that focus on domestic public health. Most fellowships that include an MPH are focused internationally, namely building international EMS systems, teaching EM ultrasound, etc. Also, I want to work directly in a public health department on the decision-making end, instead of performing research during an EM fellowship that may or may not have any influence on people implementing policies. I do like the idea of trying to custom-build a fellowship....

 

[AMEHigh]

Awesome, emergentmd, this takes a lot of pressure off. I'd still work really hard to try to do 2-3 shifts/month to maintain skills, but good to know that in terms of job hunting, it won't shut me out.

TimesNewRoman, I've found very few EM fellowships that focus on domestic public health. Most fellowships that include an MPH are focused internationally, namely building international EMS systems, teaching EM ultrasound, etc. Also, I want to work directly in a public health department on the decision-making end, instead of performing research during an EM fellowship that may or may not have any influence on people implementing policies. I do like the idea of trying to custom-build a fellowship....

I just stumbled across this post by accident. I've also thought about doing the EIS after residency (family medicine). I'm sure talking to people who have gone through the program will be able to give you info about the time constraints. But it seems like you would be able to do 1-2 shifts per month.

I don't have my grand career plans figured out yet, and although I think it'd be nice to get EIS "out of the way" right after residency, I think I want to practice as an attending for 3-5 years first. Then, go back to get a masters or do EIS and slowly transition out of practicing clinical medicine after that.

I think working on my own as an attending for a few years out of residency will give me a lot more experience and carry me forward in a career in public health instead of jumping right in to the public health side of things right after residency. I sporadically look at random jobs at non-profit organizations and some of them specify they want the doctor to have 3-4 years of clinical experience after residency before considering them.

Good luck on your decision! I'd love to know what you ultimately end up doing.

 

[fantasty]

While the EIS fellowship is a great opportunity, it's in no way the only way to get to what you're interested in. As others said, you could get your MPH while still working a reasonable amount in the ED. I was in school with ED docs doing that. (I believe they might have even had a emergency med fellowship, but they were definitely still practicing independently at the same time as coursework).

Another option to consider - Preventive medicine residency. You'll get your MPH, as well as direct work exposure to public health, particularly in health departments (as well as possibly agencies like the CDC and state health departments). Depending on your focus, you can tailor to meet your career needs (whether you're specifically interested in global emergency med, disaster preparedness, or healthcare systems like [whatever the correct term is for pre-ED EMS - sorry, not an EM person].

Many PM trainees go on to become dual-boarded. Most are in a primary care specialty... but there's no reason that EM wouldn't be an option. And, you'd get clinical contact as part of your official training, and likely have the option to moonlight on top of that.

 

[holabuster]

Many thanks to both of you! AMEHigh, cool to know you're looking towards the same type of work and great point that having 3-4 years of post-residency experience makes you more attractive for different non-profit sector jobs. Fantasty, I definitely am considering preventive medicine residency as well and have reached out to a few EM-trained PMR residents asking how much time they have to do clinical work. Could be a good way to get my MPH, though you're right that I could just do it part-time with EM. Some people I've talked to though said EIS opens more doors than PMR.

 

[deleted547339]

Awesome, emergentmd, this takes a lot of pressure off. I'd still work really hard to try to do 2-3 shifts/month to maintain skills, but good to know that in terms of job hunting, it won't shut me out.

TimesNewRoman, I've found very few EM fellowships that focus on domestic public health. Most fellowships that include an MPH are focused internationally, namely building international EMS systems, teaching EM ultrasound, etc. Also, I want to work directly in a public health department on the decision-making end, instead of performing research during an EM fellowship that may or may not have any influence on people implementing policies. I do like the idea of trying to custom-build a fellowship....

http://georgetownemergencymedicine.org/fellowships-2/health-policy-fellowship

https://smhs.gwu.edu/emed/education-training/fellowships/health-policy

http://www.ucdmc.ucdavis.edu/emergency/education/fellowship/healthpolicy.html

I think Emory may have something too.

 

[holabuster]

Thank you, TimesNewRoman, these are great opportunities to do EM clinical work and also get exposure to health policy. I especially like the Georgetown program at 1 year long. Woot! I really appreciate everyone on here's guidance. Love this forum!

 

[DeadCactus]

There is no moonlighting in the EIS program. You're on call 24/7 to go to outbreaks and do your thing. I know of at least one EM resident who went straight from residency to fellowship, they made the transition back to medicine without too much difficulty.

While there are similar options, I feel like a lot of advice here is failing to appreciate the unique value of the fellowship in terms of experience, street cred, and networking. If you're goal is to be part of the government public health machine, the program is a unique opportunity.