Any recent toxicology fellows on here?

[pillowsnice]

Interested in pursuing a tox fellowship, and I felt that the competitiveness of the fellowship was historically not very difficult. However, I saw on the match data this year that 20 applicants went unmatched into toxicology with no unfilled positions. AFAIK this is the first year with more applicants than positions offered.

Is tox inherently becoming more competitive due to the poor job landscape of EM? And if so, what can I do during residency to improve my chances of matching tox?

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[DeadCactus]

Hopefully a recent toxicology fellow chimes in. It seems like toxicology is a lot more variable in how competitive it is each year. Some years seem crazy competitive and some years don't see enough applicants for programs with the top programs always being competitive. The job market and growing negativity in clinical emergency medicine may be driving some of it but I have to think there are a lot of 1 year training options that would be more likely to benefit from those trends. I do think more people are being exposed to the specialty through a number of new fellowships and rotations as well as more social media activity, so maybe we will see a more continued rise in how competitive the specialty is but I don't think anyone can do anything but speculate at this point.

There is nothing special about applying to toxicology. The same things hold true for any fellowship: show interest early, network, try to squeeze in an academic project.

 

[miacomet]

Hopefully a recent toxicology fellow chimes in. It seems like toxicology is a lot more variable in how competitive it is each year. Some years seem crazy competitive and some years don't see enough applicants for programs with the top programs always being competitive. The job market and growing negativity in clinical emergency medicine may be driving some of it but I have to think there are a lot of 1 year training options that would be more likely to benefit from those trends. I do think more people are being exposed to the specialty through a number of new fellowships and rotations as well as more social media activity, so maybe we will see a more continued rise in how competitive the specialty is but I don't think anyone can do anything but speculate at this point.

There is nothing special about applying to toxicology. The same things hold true for any fellowship: show interest early, network, try to squeeze in an academic project.

How does toxicology get one out of clinical EM?

 

[EthylMethylMan]

How does toxicology get one out of clinical EM?

I'm not a toxicologist, but my understanding from talking to tox fellows is that you're aiming to work at a local poison center or other consulting to service, and/or do academics. I get the impression from them that the tox consultant jobs aren't the easiest to come across.

 

[DrDrummer]

I'm not a toxicologist, but my understanding from talking to tox fellows is that you're aiming to work at a local poison center or other consulting to service, and/or do academics. I get the impression from them that the tox consultant jobs aren't the easiest to come across.

You can also work for pharmaceutical companies, though I think this is fairly rare.

 

[DeadCactus]

How does toxicology get one out of clinical EM?

Same way anything else does. You convince someone either through academic, clinical, legal, political, or industrial productivity to give you money. How easy that is depends on personal interests, ability, and luck.

 

[miacomet]

Same way anything else does. You convince someone either through academic, clinical, legal, political, or industrial productivity to give you money. How easy that is depends on personal interests, ability, and luck.

So, again, exactly how does a toxicology fellowship help?
You could start work two years earlier and save money sooner for a faster exit from ER.

 

[DeadCactus]

How does being able to make income from something other than working ED shifts help you not work as many ED shifts? It doesn't seem like you really have a question just a general negativity toward toxicology and/or fellowships for whatever reason. Grinding it out in the ED for however many years to retire as early as possible is not the same goal as tailoring a career to what you want to spend your time doing and avoid burn-out. The idea that those 2 years will get you out of EM faster than a fellowship also requires a large number of assumptions about the finances of the two jobs, the specifics of the toxicology trajectory, and that the goal is zero EM as quick as possible rather than less EM or an eventual transition out. This is true any additional training or skills. Hell, you could replace toxicology with real estate investing or running a gas station.

 

[The Knife & Gun Club]

So, again, exactly how does a toxicology fellowship help?
You could start work two years earlier and save money sooner for a faster exit from ER.

I mean getting a job where more of your clinical time is spent doing tox consults rather than working ED shifts is the goal. Some toxicologists do 0 ED shifts and are 100% consults. Or they can do some cocktail of academics where they’re doing some EM but the number of shifts is low and it’s offset by having residents and doing teaching or research.

I’d say it’s a viable exit strategy except that the market for those positions that are truly 0% EM are tough to come by.

 

[Brigade4Radiant]

Most tox guys I knew had to do a few shifts but they did adult and peds EM and they would mostly get consults from the PICU

 

[FirstOrderMetabolism]

I'm 3 years out from fellowship.
I suggest e-mailing ACMT if you want to get a perspective on the trend over the last three years and breakdown by primary specialty.

To me Tox is not a fellowship that people do or people should do to get out of EM.
There is a large additional knowledge base.
The Occ Med part is profitable and not part of the EM curriculum.

Academics takes far more time, I spend months writing grants, and has its own stresses. Not better, not more, not fewer. Different.
Tox as a specialty also has its own issues that spring from how many of its services it provided free and not clearly establishing the value of its services. It is, thus, an easy target for cost-cutting. Most junior faculty I know are given a miniscule shift reduction.