Best fellowship for marketability

[strongboy2005]

Was wondering your opinion on which fellowship within emergency medicine makes one the most marketable. Pediatric EM? Toxicology? Critical care? Something else?

Note that I don't necessarily mean what will make the most money, but what will allow the emergency physician to have the best chance of getting a job if/when the job market for emergency physicians tightens up.

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[Bojack Horseman]

I'm not really qualified to answer this question... but if I had to guess I would say ultrasound

 

[Braves123]

I thought it said breast fellowship for better marketability....I actually considered doing gen surg-->breast fellowship prior to decision for EM hehe

 

[DeadCactus]

Ultrasound, Pediatrics, and Administrative fellowships seem like the ones most applicable outside of an academic setting...

 

[BADMD]

Fellowship is going to be helpful mostly within an academic place.

Ultrasound trained people really don't have that much to do at a community place. You may be able to set up a QC program or something similar with scans done by the EPs, but realistically, most EPs are coming in to work their shift and then go home. Plus, radiology is trying to stuff the ED U/S back in the bag...especially once we try to bill for it. It wouldn't surprise me one bit if many rads departments demand that they do the Q/C if such a program exists. HBUSM has more applicability to the community setting than one would think. Wound care is huge potential money. A well run collaboration between a vascular surgeon and HBUSM trained EP can be a gold mine. Bent patients and CO will be the exceptions however, most diving will be for wound care. (Did I mention that wound care is awful?)

Administration can be useful, but you probably want to have a degree that goes with that fellowship. There are ways to get the same or even better credentials just as quickly or faster (MBA, MHA). Administration probably has the broadest appeal, but you will only appeal to a place that is looking to get someone into administration.

As for academia, Tox and US are probably the easiest to use to get your foot in the door. Most programs have a tox guy or two lying around and it is a recognized part of EM training. Moreso if there is a Poison Control Center associated with that hospital. The ACGME is very interested in US. Pretty much every program will need someone who is ultrasound trained in order to put together a training program and ensure the residents are getting a sufficient US experience.

Peds is less useful and unlike the others, probably pigeon holes you more. EMS isn't that interesting to most programs although I'm sure many recognize the utility.

 

[tkim]

had a guy several classes ahead of me hired in the PNW specifically because he was peds EM trained. no other way into that area for the guy - no contacts or networking. he splits his shifts 50/50 in adult and peds ED.

 

[Birdstrike]

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[WilcoWorld]

I do not think it's a good idea to do an ultrasound fellowship for "marketability". Calling it saturated is an overstatement, but it's not that hard to come by a fellowship-trained ultrasonographer these days.

I think that Peds EM folks can still write their ticket to just about anywhere. However, I can't say for sure that things will remain that way after the 3 years it takes to do the fellowship (though it probably will).

In any case, it's not so much doing the fellowship as it is what you do with it. If you publish 3 good manuscripts and secure grant funding during your fellowship - you'll get yourself hired.

 

[namethatsmell]

To flip the question on its head...are there fellowships that make you LESS marketable?

For example, if somebody does a disaster med or international med fellowship does this end up making it more difficult to land jobs outside of academia? I could see a community employer being leery of the possibility of you asking for time off (with little advance notice) to respond to an earthquake or wanting to go to the 3rd world for 5 weeks...would they prefer an EM doc with no fellowship but who's just as clinically capable and has less disruptive professional interests?

 

[logos]

I do not think it's a good idea to do an ultrasound fellowship for "marketability". Calling it saturated is an overstatement, but it's not that hard to come by a fellowship-trained ultrasonographer these days.

I think that Peds EM folks can still write their ticket to just about anywhere. However, I can't say for sure that things will remain that way after the 3 years it takes to do the fellowship (though it probably will).

In any case, it's not so much doing the fellowship as it is what you do with it. If you publish 3 good manuscripts and secure grant funding during your fellowship - you'll get yourself hired.

My perception has generally been the opposite. Peds EM fellowships are generally full of pediatricians because they can make more than general pediatricians which is still generally less than EPs.

Whereas I have have seen US fellows from our program (a relatively new fellowship that is very inbred, no fellows yet from outside residency programs) get excellent jobs. Basically straight from fellowship into an academic program as ultrasound director. One US trained attending was stolen away from us by a private group. They wanted to start billing for their bedside US and needed someone to train up their staff and QC their images.

And this is from someone with no interest in either...

 

[Birdstrike]

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[logos]

Curious. Has your income gone up by doing and billing for ED ultrasound? Also, are you doing any regional stuff, i.e., femoral nerve blocks, femoral nerve catheters for hip/lower extremely fxs, etc? PM me if you want.

I'm not. I have about the least interest in ultrasound of anybody. Want to do a critical care fellowship.

Our US trained folks do femoral nerve blocks and I think they do make some sense. I did one interscalene block for a shoulder reduction and thought it was the best thing since sliced bread.

A private group took one of our RDMS attendings for a "ultrasound director" and our programs ultrasound fellow from this year got a great job a a relatively local academic EM program as US director. I can only imagine that the opportunities would only be better if one trained at a well established US fellowship.

 

[McPoyle]

Where would CCM fit into this? Does anyone here have any personal insight into this pathway and marketability post training?

 

[docB]

had a guy several classes ahead of me hired in the PNW specifically because he was peds EM trained. no other way into that area for the guy - no contacts or networking. he splits his shifts 50/50 in adult and peds ED.

I do not think it's a good idea to do an ultrasound fellowship for "marketability". Calling it saturated is an overstatement, but it's not that hard to come by a fellowship-trained ultrasonographer these days.

I think that Peds EM folks can still write their ticket to just about anywhere. However, I can't say for sure that things will remain that way after the 3 years it takes to do the fellowship (though it probably will).

In any case, it's not so much doing the fellowship as it is what you do with it. If you publish 3 good manuscripts and secure grant funding during your fellowship - you'll get yourself hired.

I echo peds as being the most marketable fellowship by far. I too have seen people get jobs in tight markets because they can run the peds ED. I'd also point out that the EM/Peds guys are the most marketable because they can cross into the adult ER. That also helps out with their pay as adult makes more $.

 

[logos]

Where would CCM fit into this? Does anyone here have any personal insight into this pathway and marketability post training?

I don't get the impression that it is particularly marketable at the moment.

Someday it might be as the specialty divides into the majority that just want to practice urgent care and the rest of us who want to treat sick folks.

 

[member11223344]

my understanding is that depending on where you are, medicine/anesthesia cc docs can do a pretty good job of boxing out EM-CC docs in the ICU, particularly in academic centers or large cities. one of the attendings at my institution, which is a large academic center in a major city, has a major leadership role in the ED, but has to go to a smaller, community hospital to do any time in the ICU. that said, he does manage to do both, and seems happy doing so.

 

[EctopicFetus]

With regard to community medicine it is PEDS by far. If you can find a community shop that has a dedicated Peds ED they are dying for adult EM guys who are peds fellow trained. They love the 6 Peds/EM (dual residency) guys who finish as well but 6 is a low low number.

IMO US/CCM have little to no value in the functional community ED. CCM is cool but how does that play a role in an ED? More importantly if you want to attend in the ICU it takes away your ability to work in the ED and as noted there isnt a glut of BCEM folks. IMO administration a far 2nd.. but 1st by far is Peds..

 

[TylerDurden]

As an EM/peds EM doc, I would agree that peds improves your marketability. However, I am not sure it is to the extent portrayed above and certainly is not universal. There are EDs that do not treat many kids and have no interest in doing so, because the reimbursement for kids is low. There are others that treat kids but do not feel they need a board certified PEM doc to do this. There are also dedicated peds EDs that prefer peds/peds EM trained docs over EM/peds EM. It depends a fair amount on the particular hospital as well as geography. Some areas are well saturated with peds EM.

I think CCM does create opportunities but they tend to be in the community. There are not enough critical care docs outside of academics. My buddies who did EM/CCM (the non-board certified pathways) get unsolicited job offers regularly from community hospitals.