A Little Friendly Advice, Please

[binswanger]

I want some people to give me their thoughts and advice on my situation.

I'm a second year family medicine resident at a community based hospital. It has become clear to me over the past 2 years that I really should have done an ER residency. I enjoy family medicine but emergency medicine is really where my heart is. I want the proper training (I wish the FP / ER combined residency would have been around when I was applying) and to be able to work in any ER I wish so I am considering applying in the upcoming match for ER residencies.

What are my chances of getting a spot - - will it work against me that I have prior training?? Are the funding issues enough that some programs won't even consider taking me?? Should I try to get a vacant spot at the PGYII level at a ER program as advertised on SAEM?? Let me know what you guys think and no I don't have any desire to do a FP Emergency Medicine Fellowship. What do you guys think??

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[BKN]

I want some people to give me their thoughts and advice on my situation.

I'm a second year family medicine resident at a community based hospital. It has become clear to me over the past 2 years that I really should have done an ER residency. I enjoy family medicine but emergency medicine is really where my heart is. I want the proper training (I wish the FP / ER combined residency would have been around when I was applying) and to be able to work in any ER I wish so I am considering applying in the upcoming match for ER residencies.

What are my chances of getting a spot - - will it work against me that I have prior training?? Are the funding issues enough that some programs won't even consider taking me?? Should I try to get a vacant spot at the PGYII level at a ER program as advertised on SAEM?? Let me know what you guys think and no I don't have any desire to do a FP Emergency Medicine Fellowship. What do you guys think??

Although there are EM PG1-2-3 programs, 2-3-4 programs and 1-2-3-4 programs, ABEM considers them all starting at EM1, so as far as ABEM is concerned, there's no difference between the first 2 types.

As to whether the FM training wil hurt or help, trhe answer is yes. Clearly the institutions will prefer to get all the money they can from medicare to train a resident. Balance that against the maturity and experience that you can offer. Some programs (mine for instance) actively recruit non-trads, others have no interest.

Should you try to get a vacant postion right now? Well it can't hurt to try, but it'll have to be an EM1.

Other thoughts, some programs look warily at people who quit a program before finishing as it's often a sign that something else was going on. People often resign in order to avoid firing. This can be handled by a letter from your losing PD saying you were in good standing and he regrets your leaving. Others may be concerned that you quit one residency and ight quit another. Don't know how to handl that one unless you complete the FM residency while applying to EM.

One last thing, Although you missed the EM/FP residency boat, there's still the possiblity of credit for rotations taken during the FP residency. If a new resident has comleted two years of another specialty training within 5 years of starting the EM residency, up to 6 months of credit can be given. It has to be pursued after you contract is signed, your PD has to be willing and he has to apply for you specifying which months are being substituted for specific months in his curriculum.

Overall, I think you should be optimisitc. Several people do this every year.

Hope this helps.

 

[Pelivar]

Binswanger,

Christiana will be starting an EM/FP program next year (most likely 2 spots in the 2007 match). I talked to our program director and he said that a resident with 1-2 years of FP training could come to our program and get 1 year of credit and then finish the final 4 years at christiana. The combined program is 5 years and structured similiar to EM/IM except the IM is FP. We may be able to take someone as soon as this summer. You should e-mail our Program Director, Dr. O'Connor ([email protected]) and see what he thinks.

Pelivar

 

[GeneralVeers]

Unfortunately prior training doesn't count towards EM and you'll have to start as an intern again. Some programs do take residents with previous training. Right now we have an IM resident who completed a fellowship in Geriatrics before starting over again. The guy should be working as an attending but is a lowly intern once more.

 

[corpsmanUP]

If I were you I would just finish your FM training and try to get a spot in a newer EM program when you are done. For instance, go to the University of Iowa program's website and see how many of my upper levels are FM boarded. There are I think 3-4 who are boarded and out chief resident is actually peds boarded. This was one of the main reasons I loved this program...maturity of the upper levels who all have had nearly 6 years of residency training!! Coming from a background as a family medicine PA for several years it was important that my upper levels be able to know what I am capable of. I truly believe that the FM trained people make great EM docs not because it makes them better at EM, but because it makes them better at the FM aspects of EM (which as wel all know is probably a large percentage of EM in many places). Just knowing all the drugs people take in the outpatient setting is highly valuable, and knowing the capabilities of outpatient docs makes you a better EM doc so you can feel comfortable letting someone go to follow up with their PCP.

New programs are almost always trying to recruit prior trained people for their programs so seek them out. I can tell you that you would be highly valued at the U of Iowa, so apply and come interview!! You won't be sorry.

 

[binswanger]

I appreciate everyone's reply, I was planning on finishing my FM residency for several reasons - - one is that I will be Chief next year and that would really screw over the program and fellow residents and I don't want to that. Its not as if I loath FM, its just that I don't want to do it for the rest of my life. I guess given the fact that no matter what I will basically be starting over as an intern I will just apply through the match and see what happens. If anybody has any thoughts let me know........