Pig Bodine

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Hello there,

I'm a 4th year trying to decide what career direction to pursue, along with everyone else this time of year. I like both Family and EM and am strongly considering doing both residencies and the combined programs don't appeal to me for location reasons. I'm probably destined for rural practice, truly rural i.e. from AK and would like to go back and work in the bush and I think that while fellowships and EM heavy FM residencies may give some exposure there's no substitute for the training in initial stabilization management that an EM residency provides. I know that programs like Ventura, Martinez, etc. certainly train you well in all aspects but how do they do in terms of this?

A physician in Jackson, WY, I believe, has done this, anyone know about any other double boarded docs? Futhermore, would training time be reduced if one went from EM to FM or vice versa or would it be 6 years minimum? Which one would you do first? Please enlighten this troubled newcomer...
 

Emedpa

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folks who I know who have done both did fm first and got 6 months off their required em residency time due to overlapping rotations(icu, etc) so did 5.5 yrs.
they were able to moonlight in fm clinic or urgent care during their off days from em residency.
why doesn't the dual em/fp program appeal to you?
although an unpopular option here you could do a "cowboy fm program" like ventura, contra costa, etc followed by a 1 yr family medicine em fellowship(see below) and do quite well in rural em. I have a good friend who did this who is now director of a rural e.d.(level IV) that hires both em and fm physicians.
you wouldn't be able to work metro or academic em with this but it sounds like you don't want to do that anyway....

family medicine fellowships in emergency medicine:

Sparks Health System Emergency Medicine Ft. Smith AR
Premier Health Care Services, Inc. Emergency Medicine Dayton OH
University of Tennessee FMRP Emergency Medicine Jackson TN
University of Tennessee Emergency Medicine Knoxville TN
Premier Health Care Services, Inc. Emergency Medicine Huntington WV

fellowships may make you eligible for alternate pathway ABPS EM (not abem) board certification:
http://www.abpsus.org/certification/emergency/eligibility.html

Daniel Stern and Associates released the results of its 2009 Annual National Emergency Physician Salary & Benefit Survey. One thousand and nine (1,009) physicians participated in the 24th salary survey, responding from 50 states and the District of Columbia.
Some interesting facts in this survey of the 1,009 respondents:
• 28% of Emergency Department Directors accept AAPS/ABPS Emergency Boards.
 
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ArkansasRanger

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I was just reading an article by the AAFP introducing new combined FM / EM residencies approved by both the FP and EM bodies. That's cool beans if you ask me, but it was still five years long. I think four would be sufficient personally, but I'm a nobody.
 
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Emedpa

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I think you could do it in 4 as well.
here is a generic schedule for an em residency:
PGY-1
Orientation: 1 rotation
Emergency Medicine : 6 rotations
ICU : 1 rotation
OB/GYN : 1 rotation
ICU : 1 rotation
Trauma Service : 1 rotation
Emergency Medicine : 1 rotations
Anesthesia : 1 rotation
PGY-2
Emergency Medicine : 5 rotations
ICU : 1 rotation
Emergency Medicine : 2 rotations
Trauma : 1 rotation
CCU : 1 rotation
Orthopedics :1 rotation
Toxicology : 1 rotation
Pediatrics : 1 rotation
PGY-3
Emergency Medicine : 6 rotations
Trauma : 1 rotation
Emergency Medicine : 3 rotations
Elective: 1 rotation
Administrative : 1 rotation
Community ED: 1 rotation

here is the schedule for a high end fp residency(ventura):
1st Year:
Inpatient Medicine/Pediatrics - 16 weeks
Obstretics/Gynecology - 8 week
Surgery - 8 weeks
Community Medicine - 4 weeks
Intensive Care - 4 weeks
Orthopedics/Sports Medicine - 4 weeks
Outpatient Pediatrics - 4 weeks
Elective - 4 weeks
Vacation - 4 weeks

2nd Year:
Inpatient Medicine/Pediatrics - 16 weeks
Outpatient Specialties - 10 weeks
Obstretics/Gynecology - 8 weeks
Emergency Medicine - 4 weeks
Outpatient Pediatrics - 4 weeks
Surgery - 4 weeks
Night Float - 2 weeks
Elective - 4 weeks
Vacation - 4 weeks

3rd Year:
Outpatient Specialties - 10 weeks
Inpatient Medicine/Pediatrics - 8 weeks
Emergency Medicine - 4 weeks
Intensive Care - 4 weeks
Obstretics/Gynecology - 4 weeks
Orthopedics/Sports Medicine - 4 weeks
Outpatient Pediatrics - 4 weeks
Surgery - 4 weeks
Night Float - 2 weeks
Elective - 8 weeks
Vacation - 4 weeks

a combined 4 yr program would have no electives, and more time in em than the ventura county program above. they already have similar amts of trauma and icu.
kind of like this:
http://www.christianacare.org/residentbody.cfm?id=1686 (minus all the electives and the 2 admin blocks)
 
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Hamhock

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In regards to the original post:
If you choose to do both an EM residency and an FM residency, I suggest EM first. I have three reasons, none of which are great, but may be worth something:
1. an EM spot is harder to get in general; there are a lot more FM programs that will take you after an EM residency that the other way around (although it is definitely possible)
2. I have no data for this, but I am guessing you would make a lot more cash if you were moonlighting as an ED doc during an FM residency in limited hours that moonlihgting as an FM doc during a FM residency
3. the great majority of IM/EM docs (I know, not FM/EM) docs choose to do only EM after residency...maybe you can save yourself three years (of course, I am an EM resident and therefore very biased...and it sounds like you are very interested in rural medicine).

emedpa, could you please explain, "although an unpopular option here you could do a "cowboy fm program" like ventura, contra costa, etc"? Why is this so? And what exactly did you mean?

If I was going to do FM, "cowboy programs" like Ventura and Contra Costa seemed the way to go as far as I was concerned...but a lot of that is my personality.

HH
 

Emedpa

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emedpa, could you please explain, "although an unpopular option here you could do a "cowboy fm program" like ventura, contra costa, etc"? Why is this so? And what exactly did you mean?
If I was going to do FM, "cowboy programs" like Ventura and Contra Costa seemed the way to go as far as I was concerned...but a lot of that is my personality.

HH

I meant doing a cowboy program THEN doing an fp em fellowship and practicing em is unpopular here. no one is against cowboy fm programs and going into fm. if I was going to do fm full time as a D.O. I would look for a residency like this.
the dominant theme in the em forum is "only residency trained/boarded em docs have any place in the emergency dept".
in my opinion this is not the case as I know several fine fm physicians practicing em full time and a large # of pa's practicing em full time in a solo capacity in small depts.
 

ArkansasRanger

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I meant doing a cowboy program THEN doing an fp em fellowship and practicing em is unpopular here. no one is against cowboy fm programs and going into fm. if I was going to do fm full time as a D.O. I would look for a residency like this.
the dominant theme in the em forum is "only residency trained/boarded em docs have any place in the emergency dept".
in my opinion this is not the case as I know several fine fm physicians practicing em full time and a large # of pa's practicing em full time in a solo capacity in small depts.

Where I come from the community hospital emergency department in a city of about 25,000 was staffed solely by FPs with one on shift. Eventually they hired a neonatologist, but I'm not sure if he is still there or not. The hospitalist (a relatively new position there) and ED folks are all FPs, and there's an unchallenged (is that the term) FP (AHEC) residency in town. The wound care / hyperbaric center was even staffed by an FP guy from India or some such place. The only other physicians I knew of being on staff were three radiologists, and the chief of staff, a position that seemed to "rotate" more than anything else was a D.D.S. OMFS.
 
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Pig Bodine

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Thanks for the info,

I'm thinking I would probably do EM first, simply because the greater difficulty in getting a spot. Not really interested in the combined programs simply because I can't live in Delaware or Louisiana, let alone for 5 years. I do, however, think that 5 years is an appropriate length of training, but then I think that Family should be 4 years, probably not the most popular stance here :). Concerning moonlighting, the last thing I want to do with my free time in Training is spend it working a shift although it would be nice to have the option.

As far as the EM/IM docs doing one or the other that makes perfect sense, to me anyway, because IM and EM are totally different specialties. I think that FM and EM are much more aligned and pretty much perfect for what I would like to do and would allow me to be well trained in literally anything that comes through the door. For me it's more a question of competency, and again, I don't think that the fellowships provide that although they certainly do give some exposure. The boards that you can sit for after doing this are not ABMS recognized, correct? Also, very interested in the powerhouse CA Family programs but it would also be nice to get back to AK at some point despite being fairly new program and not quite on par with the Vertura's and Martinez's.

Interesting point about the reduced time in EM off service rotations from time spent in FM, any idea if this goes the other way? Again, you are a useful resource as always and pretty happy to see a rural Family Doc as the Surgeon General!
 
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