Most suitable path for EM --AND-- FM?

[JakeHarley]

I will be starting MSI at a DO program this fall, and while it’s too early to know for sure what I will want to do, I already feel very drawn toward family practice and emergency medicine, and suspect that I will end up having difficulty choosing between the two when the time comes.

The generalist nature of both specialties appeals to me. However, I am attracted to both the small private practice potential of family medicine and the sense of immediacy in emergency medicine. So, it would seem most fulfilling to be able to work in both environments.

While it is possible at this point for a family practice physician to work in a small ER, and many (including my PCP) do just that, it is unclear to me how far into the future that will be doable. If I train in family medicine, will I have the same opportunity 8-10 years from now?

What do you guys think is the best path to take in order to leave both options open?

-Gun for a combined FM/EM residency, either MD or DO;

-Pursue FM, and hope to be able to moonlight in a small ER;

-FM followed by an EM fellowship

-EM, practice for several years, then pursue retraining in FM;

-Something I haven’t thought of…

Thanks in advance—

Jake

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[SoCuteMD]

Disclaimer: my statements are not fact. They are my opinion and are based on what I have read on these boards over the past few months. More experienced people, feel free to correct me!!!

Ok, first of all, to get into EM there is no need to "gun." Please don't. Be kind to your classmates.

The EM/FM combined programs are relatively new, and given that the word on the street regarding the other combined programs is that they are not ridiculously competitive, I doubt EM/FM will be either. You will certainly need to be a solid applicant, but you don't need to cure cancer in your first year (that can wait 'til second).

As far as FM with hopes of working in an ED, it sounds like this is slowly coming to an end. My sense (gathered from this board) is that you would find yourself being limited geographically to some pretty rural areas with a few suburban possibilities thrown into the mix.

FM followed by an EM fellowship DOES NOT lead to EM board certification, so you might as well not bother (again, the sense I get on here).

Being a "retread" as BKN (a program director who hangs out here) likes to call it (FM to EM, but you are talking the opposite) is something that is possible, but think about this carefully. Are you really going to want to go from making six figures back down to 40 or 50K, working up to 80 hrs/wk, and taking call (at least on non-EM services)?

You've got PLENTY of time. All you need to do is work hard for the first two years, take the boards and do well, and then you've got all of third year and the early part of fourth to answer your questions.

 

[JakeHarley]

Ok, first of all, to get into EM there is no need to "gun." Please don't. Be kind to your classmates.

I only meant it in the most touchy-feely sense. I'm not really the 'gunner' type.

Thanks for your thoughts.

EDIT:

So, you are suggesting that the only sure way to practice in both specialties 10 years down the road will be through dual board certification, i.e., by pursuing one of the FM/EM combined training programs?

 

[turtle md]

The key to matching in EM is to multi-post, i.e. , on SDN, preferably before, but at least during, the entirety of the Match process.

 

[SoCuteMD]

I only meant it in the most touchy-feely sense. I'm not really the 'gunner' type.

Thanks for your thoughts.

EDIT:

So, you are suggesting that the only sure way to practice in both specialties 10 years down the road will be through dual board certification, i.e., by pursuing one of the FM/EM combined training programs?

It is my sense/understanding that if you want to choose the geographic area of your practice ten years down the line and wish to practice in both, that you will need to be double-boarded. If you don't care where you are dragging your presumptive (current or future) wife and kids, then you could probably get away with just FM. However, keep in mind that 10 years only puts you at the beginning of your career. In 30 years, who knows? I'm betting that as the years go on there will be fewer and fewer FM docs hanging around the ED.

 

[Telemachus]

If you're about to be an MS1, then keep in mind that you have 3 years to get a better feel of each specialty before you even have to apply for residencies. Seek out opportunities to spend time exploring each one, and you may find that you develop a strong preference for one over the other, and you may even decide you like a third option even more. Don't worry about figuring it out right now......

 

[bartleby]

Forget the EM fellowship option. If you're going to bother, you might as well spend the time to become board certified, which this does not allow. Those who are not board certified are essentially shut out of the desirable jobs. They are increasing less able to work in the second tier jobs as well. Expect this trend to continue as more EM grads enter the marketplace.

If you're dead set on being boarded in family med (search the forums for extensive discussion of the pros and cons of working in primary care alongside or after EM), the dual certification residencies seem like the best deal.

 

[swaamedic]

If you do EM, you can always open an Urgent Care clinic which is basically family medicine w/ a little less continuity. To my knowledge there is no 'board' as of yet for urgent care medicine (although i do forsee FM perhaps trying to claim this specialty in the future). Just a way for an EM trained Dr. to do FM w/o the additional years of residency.

 

[MeeraDO]

I am starting EM/IM this July and can't wait. Seems as though I will get the opportunity to pick and choose what I want to do later on...although I am not that excited at doing EM...I chose the program so that I can always work a few days a week even when I wanna start having a family

 

[JakeHarley]

I am starting EM/IM this July and can't wait. Seems as though I will get the opportunity to pick and choose what I want to do later on...although I am not that excited at doing EM...I chose the program so that I can always work a few days a week even when I wanna start having a family

First: Thanks for using your first ever SDN post to reply to my thread

Second: How was the match for you? Are the EM/IM programs competetive relative to EM?

 

[8744]

What do you guys think is the best path to take in order to leave both options open?

Dude....

Why don't you spend some time in medical school before you commit to either EM or the Specialty That Dare Not Speak Its Name? You're making no sense. You either want to work in an Emergency Department handling mostly acute stuff or you want to work in the typical Specialty that Dare Not Speak Its Name outpatient clinic handling mostly non-acute, chronic conditions.

 

[JakeHarley]

Dude....

Why don't you spend some time in medical school before you commit to either EM or the Specialty That Dare Not Speak Its Name? You're making no sense. You either want to work in an Emergency Department handling mostly acute stuff or you want to work in the typical Specialty that Dare Not Speak Its Name outpatient clinic handling mostly non-acute, chronic conditions.

EDIT (deleted previous post):

Obviously, I am not committing to anything, only checking out some things I am interested in.

Thanks for taking the time to offer your input.

Take care,

Jake