Anyone hear of gas attendings working ER shifts?

Discussion in 'Anesthesiology' started by joshmir, Mar 25, 2004.

  1. joshmir

    joshmir Senior Member
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    Maybe it only happens out in the sticks...

    Maybe it only happens in huge trauma centers...

    Maybe it's only people who grandfathered into EM board certification...

    I just know that some ER docs work only three 8hr shifts a week, and I wonder if anesthesia can set you up to do that.

    I've heard FP folks in the ER make half of what board certified EM docs make per hour...I guess gas guys would be in the same boat.

    Any thoughts? Any knowledge? It would make me feel a lot better knowing I could segueway there if the OR ever got to stuffy...

    Would retraining be difficult b/c you would not be funded for a second residency?
     
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  2. joshmir

    joshmir Senior Member
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    200 reads...

    please someone reply if you've ever seen board-certified anesthesiologists working in Emergency Medicine...

    Thanks!
     
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  3. UTSouthwestern

    UTSouthwestern 1K Member
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    I do that right now as one of my moonlighting opportunities. Yes it can be done, but usually as a moonlighter and probably only in smaller community ER's or VA ER's.

    If you really want to do both, finish your anesthesiology residency and do an ER fellowship.
     
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  4. UTSouthwestern

    UTSouthwestern 1K Member
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    Primary it is the trauma/critical care fellowship, however, I have had friends contact different ER departments to arrange fellowships in EM and some programs will give you as much as 1.5 years credit for your internship and anesthesia critical care rotations towards either a residency in EM and/or fellowship.

    For example, one recent graduate of our program negotiated an agreement with an ER department in Indiana wherein he is currently working as a "3rd year EM resident" with a one year fellowship training in critical care that will incorporate the months of ICU he has already completed (4 months) into those two years and will be replaced by EM rotations to help fill out the number of EM months required to graduate. Basically he negotiated a one year residency in EM and gave up another year to be a fellow there, but who cares since he can then sit for two boards.

    Programs are out there that are flexible especially when they see a candidate who could greatly enhance their program and your intimate knowledge of pharmacology, physiology, and critical care as practiced in the OR or ICU makes you a desirable commodity.
     
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  5. gaslady

    gaslady Senior Member
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    The training for anesthesia is so different that I don't think many anesthesiologists would feel qualified to do it even if you could find a place that would let you do it. I think you would set yourself up for a lot of liability if something goes wrong. Even though the fields are both good for lifestyle, they are pretty different. As an anesthesiologist you would be well suited to handle the critically ill patients but there's a lot that you wouldn't be well trained to handle. Although FP and IM trained docs do practice EM in certain areas, the trend now is towards EM trained docs. There are residency programs that have fired their FP and IM trained ED docs and hired EM trained ones for this reason even though some of those docs were practicing EM at those institutions for years.
     
  6. EMRaiden

    EMRaiden Senior Member
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    In a word--- NO.

    But I don't think its outside the realm of reality. It all depends on the standard in the community. If your community has all BC EM trained MDs in the ED then you decrease the standard and would find it hard to get work, on the other hand if you are in a community where a group of local MD rotates ED coverage I think it would work.

    I think anes training would set you up for the really sick ED paitents who need lots of attention and care- intubation, lines, meds, etc. But for bread and butter EM-- lacs, CP, SOB, vaginal bleeding I think you'd be in over your head, and as another poster stated -- open yourself up for tremendous liability.
     
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  7. KGUNNER1

    KGUNNER1 Senior Member
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    Anyone with a valid medical license can practice in any setting if that hospital is desperate enough to grant you privileges. I could practice anesthesiology, since I am good with intubations, lines, take care of critically ill patients every day, why couldn't I? I'd just use propofol and fentanyl during the entire case. Right? Wrong... If any hospital was foolish enough to grant me privileges in Anesth, then I definitively wouldn't be foolish enough to hang myself.

    The standard of care is pretty well established in ED. If you didn't train and aren't boarded in ED, you don't belong working as an ED physician. If you do, just cross your fingers and hope nothing goes wrong, because you'll find 100 expert witnesses willing to crucify you.

    The only ER fellowships are in Peds ER (2 years for straight EM and 3 for Peds). You can't sit for boards for working in extra shifts in the ED. The RRC only allows .5 years "forgiveness" when jumping specialties. If you didn't graduate from an ABMS/RRC certified program, you can't sit for ABMS sponsored boards.

    Now if you want to go outside the ABMS, then there is the BCEM exam (board certified emergency medicine) which was formed by a bunch of disgruntled family practice/IM types who practiced ER for many years but didn't grandfather in.
     
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  8. joshmir

    joshmir Senior Member
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    Basically, i matched into gas because it was the conservative choice, but now wish i had explored the interest I had in EM. I am taking the appropriate steps to explore this, making sure it's not just "buyer's remorse", and will evaluate these thoughts during my intern year while doing EM and gas rotations. Right now i'm just trying to gather information.

    1) What are the disadvantages of being board-certified by the BCEM as opposed to the traditional route?

    2) Do you think that if I finished a gas residency, I would be able to find EM residencies that would accept me? (ie, they were not as reliant on medicare funding for residents?)

    3) If I am eligable for the same amount of funding, do you think I would have better success trying to get into an EM residency after a year of anesthesia or an intern year?

    Thanks so much for your advice!
     
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  9. KGUNNER1

    KGUNNER1 Senior Member
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    To answer your questions.

    1. BCEM is a rogue organization http://www.aapsga.org/certification/emergency/ .

    It doesn't mean those docs are bad, they just went a different route. ABMS certifies over 95% of the boards in the US (rough estimate). ABMS is the "gold standard". You will probably find a tough road with the BCEM badge, especially in academic medicine. In smaller markets, it may not make a difference, but then those markets also hire FP and IM docs.

    2. It would be extremely difficult, not impossible, but close to land a residency now-a-days after already completing another one. Especially in ER where it seems to be getting more competitive. Money is tight.

    3. I don't think it matters either way. Just learn as much as you can in this first year. You can never repeat your intern year experience. It truely is a remarkable year. Always keep a postitive attitude, you never know who you'll run into down the road.


    Good luck,
    Kyle
     
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