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Board Certification for Family Physicians in Emergency Medicine

Discussion in 'Family Medicine' started by DoctahB, Nov 16, 2018.

  1. MedicineZ0Z

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    They did a study, and I can find it in probably 2 mins, comparing FM to EM fellowship docs in Canada to 5 year EM residency trained. I think 3 or 5 years post practice, the outcomes were identical between the two.
     
  2. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Please do then
     
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  3. Lexdiamondz

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    You're literally describing every emergency room in NYC. That is literally my daily experience.
     
  4. MedicineZ0Z

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    You don't have a CT? You don't have resources in theory? And NYC is a very unique location given the whole nursing union thing among other unions/staff issues.
     
  5. Lexdiamondz

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    Machines break, dude.


    You yourself pointed out that not all ED experience is the same. You can work in a VA as an IM trained physician in the ED for years and never see trauma, rarely intubate and never see women and supposedly meet your basic criteria.

    Furthermore, a massive part of training and arguably the biggest benefit to doing an EM residency over just having EM "experience" is the structure and mentorship that comes with formal residency training. Having someone actually track your progress, given you constructive feedback and ensure you're meeting milestones is an integral part of learning to practice medicine and for the most part, you aren't going to get that level of involvement in EM-specific education outside of an EM residency.

    Also, please stop implying going to the OR some mornings is an adequate substitute for actual difficult airway training. It's not.
     
    #105 Lexdiamondz, Dec 3, 2018
    Last edited: Dec 3, 2018
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  6. MedicineZ0Z

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    I don't disagree. Just saying it varies from case by case.

    And the point was that if you record 100+ intubations, you'll become proficient at the airway. Time spent in the ED and ICU also exposes you to difficult airways.
     
  7. EmergDO

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    Being proficient at the technical skill of intubating is not the same as being good at emergent airway management.
     
  8. MedicineZ0Z

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    Depending on your hospital, you can be an FM resident who gets exposure to difficult airways or you can be an EM resident who doesn't get adequate exposure (ex. some new programs that have popped up). Your experience prior to residency counts too. I've intubated a lot in the OR but have had a bunch of (mostly, but not all) successful attempts at difficult airways in the icu and ed. I've also seen ED pgy1s in November who are terrible at it and never did it prior to residency.

    I'm not arguing for a second that anything other than an EM residency is ideal. But rather saying you can obtain reasonable proficiency as an FM in an unopposed program.
     
  9. BoardingDoc

    BoardingDoc Don't worry. I've got my towel.
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    Still waiting on that 2 min lookup....
     
  10. SpacemanSpifff

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    FPs work in EDs across the US. It's happening every day and they probably do fine. Or maybe they don't. I don't have any large data to suggest one over the other. Can they reach reasonable proficiency? Probably, depending on how you define that.

    The source of frustration, from my perspective, for EP's in this discussion is the fact that the you're operating on the margins of experience. Are there some FM grads who get exposure to difficult airways, resuscitation of toxic patients, and higher level management of an emergency department? Probably. Are these core components of the FM curriculum, a part of their every day life? No. There are incredibly smart FM docs, and incredibly dumb EM docs out there. But the baseline skill and intelligence of individuals is not the question. The experience, or possibility of experience, in a select few programs is not the question. The mission of the residency and specialty as a whole is the question. And the average experiences of an FM-trained doc are not the average experiences of an EM-trained doc at the end of their training, which is the point of specialties in general.

    The short answer to your question is no, the opportunities are not the same. EM boarded physicians own EDs in the level I and academic settings. You cannot apply for EM fellowships without completing an EM residency. You can likely serve as an EMS director without the FP to EM fellowship, depending on your setting.
     
  11. Lexdiamondz

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    This is totally irrelevant and I don't know why you would even mention this.

    Nobody cares if you've intubated prior to starting residency - whether or not their are EM interns who can't tube isn't the point. The point is what your level of skill is at the end of your training. An EM residency guarantees you at least a baseline level of proficiency in airway management. FM residency does not, and just because you think you know how to tube after doing a dozen or so "difficult" airways does not give you even close to the experience necessary to accurately appraise what skills you can realistically acquire from a training programme that isn't actually dedicated to teaching you how to manage an airway. Sit down.
     
  12. Matthew9Thirtyfive

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    Sorry for the ignorance, but I’m trying to educate myself. Aren’t peds EM fellowships open to docs who have completed or are completing a peds residency? Are there studies showing that peds trained docs with a PEM fellowship aren't as good as EM docs, or that they don't do as well after a PEM fellowship as an EM trained doc doing the same fellowship?
     
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  13. smq123

    smq123 John William Waterhouse
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    Peds EM fellowships are, I think, 3 years long. Not just 1 year, as they are in FM.
     
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  14. Matthew9Thirtyfive

    Matthew9Thirtyfive Class of 2023!
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    Ah, that's probably the difference then. Thanks for clarifying.
     
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  15. Hamhock

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    And to add more to smq123's post, there is some good evidence and an overwhelming sense that peds to pedsEM docs are far less procedure and resuscitation proficient relative to EM to pedsEM.

    Furthermore, after doing three years of training, a peds to pedsEM doc still has a much healthier population. Most pedsEM jobs are in huge academic centers with ready access to the PICU and pediatric cardiologists.

    It's just different.

    HH
     
  16. Matthew9Thirtyfive

    Matthew9Thirtyfive Class of 2023!
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    I saw something on the peds forum actually that said something similar—that peds to pem docs have much less procedural experience. That’s kind of depressing.
     
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  17. GonnaBeADoc2222

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    Yah we should totz study this. Would make a great resident scholarly research project! Whoever is advocating for FM crossover should have them and their families "randomized" to "rural" where there are FM docs to intubate and run the show. It's not like I routinely have to bail out my non em trained colleagues on airway management and vascular access literally all the time.

    Sent from my SM-G928V using SDN mobile
     
  18. MedicineZ0Z

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    Did you see the thread about midlevels getting some "fellowship" to work independently in the ER?? I feel like 99.9% of your outrage should be focused on that issue.
    I'm not even going into FM but have rotated with FMs (half a dozen who worked there) in a rural ER who were excellent and actually taught me way more than I ever lived in an urban ER setting from boarded ER docs. I performed my first chest tube there and intubated as well and everything was a well run machine.
     
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  19. Lexdiamondz

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    Mhmm.
     

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