what is a better way to do it?

[cet]

I like both EM and FM, and am trying to determine if it is easier to train and work as a family doc and do a few days a week in a small rural ED or the other way around.....Train in EM but work part time at a Family Practice office. I would like to do both even tho i know it is not traditional.

so maybe you can answer my question. Which residency EM or FP would then allow me an easier transition into doing both?

I know an EM trained doc that recently tried to get a job at a Family practice office after his burnout of 15 years. the HMOs wanted to know how many admissions he had since graduating med school. he had none in 15 years of working in the ED and the HMOs said sorry thanks but we wont reimburse you as an FP. yikes. but then I know in the rural area where i am, at the tiny hospitals, the Family docs cover the ER on home call. anyone with experience, let me know. thanks.

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[blackcat]

probably doing fp and covering in a small ed. eps are not trained in taking care of chronic conditions (and that is why we generally choose this specialty). we deal only with exacerbations of chronic diseases and acute conditions.
as an fp you will learn the management of acute conditions but not the extent of an em residency, but if the volume and acuity of the ed is not bad, you shouldn't have a problem. not to say that an fp trained person cannot cover a busy/sick ed (i know many GOOD ones), but if you only do it part time and/or don't spend a lot of time trying to learn the intricacies (and there are many) and philosophy, you may get burned.
in addition, as time goes along, it may become more difficult for an fp/gp to work in ed's as more em trained docs are produced to work in them.

in short...

em residency to work as fp - unlikely
fp residency to work as er - possible, but may become more difficult down the line.

my 2/5's of a nickel.

 

[Annette]

I did a rural FP rotation in a critical access hospital- all of 6 beds, and a 1 bed emergency room. Both docs were FP trained. There would not be enough to sustain a separate EP. It all worked fairly well- all very sick patients were shipped out to a regional hospital. From that experience, seems FP training was more important than EP training.

 

[DocWagner]

Around here, there appears to be a trend where EM groups hire FP docs to handle some of the less acute problems...they don't handle any of the trauma room things or "right off the ambulance...intubated etc" patients. Obviously more competent than PA's and NP's and speeds up the whole process. It seems to work well.

 

[anonymousEM]

As blackcat said:
in addition, as time goes along, it may become more difficult for an fp/gp to work in ed's as more em trained docs are produced to work in them.

If board certification is an issue to you (it's a hiring commodity and one day may be necessary to work in an ED), you can't sit for the American Board of EM exam without having completed an RRC Accredited EM Residency.

But, you mentioned rural places...they are the places probably last to incorporate all board certified EM Physicians due to the limited supply of people wanting to work there.

Good luck! DO rotations in both and decide if one really fits you better. There's always EM/IM Combined programs if you REALLY can't decide and are in the minority of people going into EM that ENJOY FLOOR WORK!

 

[maxheadroom]

I know a few "burned out" EM physicians who took shifts at Urgent Care centers when they quit ER. It's more or less FP clinic without appointments and no OB. But no long term stuff.