Can I practice EM after IM residency?

[alpinism]

In fairness, there is a lot of overlap in medicine.

Plenty of nephrologists do a fair bit of primary care. Plenty of OBs do primary care as well. Y'all do primary care too, probably much more regularly than you'd prefer to.

There's a large UC chain in my part of the country that loves to hire EPs who are sick of nights/high acuity work and they act as PCPs for a large number of patients (when I was moonlighting for them 3 years ago, their in-house numbers were roughly 20% of their patient encounters were long-term chronic disease management).

Would we be better off if there were enough EPs to staff every ED in the country? Sure.
Are there enough of you to do that? Not by a long shot. This is especially pertinent since there's quite a few threads where y'all are complaining about the expansion of EM residency programs.

Who is supposed to make up the gap?

The problem is that none of these new residency grads are going to work at some rural hospital for 150/hr.

---

Members don't see this ad.

 

[alpinism]

Why are we still having these discussions 40+ years after EM has already been established as a board certified specialty in every English-speaking country on the planet?

Because the leaders of our specialty sold out and choose to hire these people so they can make money.

 

[VA Hopeful Dr]

The problem is that none of these new residency grads are going to work at some rural hospital for 150/hr.

Sure, and I wouldn't either in their shoes. But the fact that none of the new grads are having a hard time finding good jobs tells me there are more jobs than there are doctors to fill them. Otherwise even the ****ty jobs would get taken.

 

[GonnaBeADoc2222]

Sure, and I wouldn't either in their shoes. But the fact that none of the new grads are having a hard time finding good jobs tells me there are more jobs than there are doctors to fill them. Otherwise even the ****ty jobs would get taken.

Raise the rate to $400/hr and I PROMISE you you'll get ABEM people from the cities to come out to BFE

 

[VA Hopeful Dr]

Raise the rate to $400/hr and I PROMISE you you'll get ABEM people from the cities to come out to BFE

Obviously, but then what about the jobs that those cities now have open? I'm reasonably certain there are a finite number of residency trained emergency physicians in America.

There are currently 38,000 board certified emergency physicians. There are just over 6,000 hospitals in America. I'm willing to bet most of those hospitals have more than 6.3 emergency physicians on staff.

 

[deleted109597]

ABPS is well respected by most State Boards including and as evident in this link for FL

Florida Board of Medicine » Advertising Board Certifications- Healthcare Practitioner Licensing and Regulation

The State of Florida's Online Resource for Medical Doctor, Physician Assistant and Anesthesiologist Assistant Licensing, Renewals and Information - Florida Department of Health

flboardofmedicine.gov

That's because Florida is such a medicolegal malpractice nightmare that they are desperate for any physicians.
Texas absolutely forbids using ABPS as a board.
Furthermore, over 90% of ABPS "boards" are for EM. It's not like the surgeons out there are getting boarded in internal medicine via them.

 

[deleted109597]

Would we be better off if there were enough EPs to staff every ED in the country? Sure.
Are there enough of you to do that? Not by a long shot. This is especially pertinent since there's quite a few threads where y'all are complaining about the expansion of EM residency programs.

Who is supposed to make up the gap?

This has been brought up before.
There aren't enough surgeons for every hospital. There aren't enough intensivists. There's not enough GI.
Except for emergency, they aren't using IM/FP boarded people to fill those roles. Even at the shops where the hospitalists take "care" of people, they don't call themselves ICU docs. And it is expected that their level of care is less than that of an ICU doc, inasmuch as the "real sick" ones get transferred to other ICUs.

Yes, there are the very, very rural shops where FP still does OB, and scopes, and whatnot. But it's incredibly rare.

Other fields seem to keep the creep of untrained people out of theirs. EM is different. PM&R is much newer as a speciality board, but FP/IM docs aren't doing that simply because 'it hasn't been a specialty that long".

 

[SKaminski]

Texas absolutely forbids using ABPS as a board.

This is factually incorrect. In fact, the Texas Medical Board explicitly recognizes ABPS certification in Emergency Medicine. This was a decision that was come to years ago, and while the EM community got upset about it, that doesnt change anything. It was renewed in 2018.

American Board of Physician Specialties - Wikipedia

en.wikipedia.org

If you dont want to trust wikipedia, here is the official website:

Texas Medical Board

www.tmb.state.tx.us

Go ahead and click on "Boards Recognized for Purposes of Advertisement Only " - List of approved certifying boards.

You'll see the last listing, "American Board of Physician Specialties - Emergency Medicine; October 2009, Renewed March 2, 2018 "

So in Texas you can legally advertise yourself as Board Specialized in Emergency Medicine if you are certified by the ABPS.

 

[deleted109597]

Except it's not that easy.
Yes, there was a loophole back in 2009.

According to the new rules, a physician may use the term "board certified" in any advertising for his or her practice if:

1. the specialty board that conferred the certification and the certifying organization is:
   1. a member board of the American Board of Medical Specialties (ABMS),
   2. a member board of the American Osteopathic Association Bureau of Osteopathic Specialists (BOS), or
   3. is the American Board of Oral and Maxillofacial Surgery;
2. a physician holds a certification that was granted prior to September 1, 2010, and whose certifying board was approved by the medical board for advertising purposes prior to September 1, 2010, or
3. the TMB determines that the physician-based certifying organization that conferred the certification has certification requirements that are substantially equivalent to the requirements of the ABMS or the BOS existing at the time of application to the medical board.

To qualify under Option 3, above, physicians must submit an application to a committee of the TMB and demonstrate that:

(1) the organization requires all physicians who are seeking certification to successfully pass a written or an oral examination or both, which tests the applicant's knowledge and skills in the specialty or subspecialty area of medicine. All or part of the examination may be delegated to a testing organization. All examinations require a psychometric evaluation for validation;

(2) the organization has written proof of a determination by the Internal Revenue Service that the certifying board is tax exempt under the Internal Revenue Code pursuant to Section 501(c);

(3) the organization has a permanent headquarters and staff;

(4) the organization has at least 100 duly licensed members, fellows, diplomates, or certificate holders from at least one-third of the states;

(5) the organization requires all physicians who are seeking certification to have successfully completed postgraduate training that is accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association and that provides substantial and identifiable supervised training of comprehensive scope in the specialty or subspecialty certified and the organization utilizes appropriate peer review;

(6) the organization provides an online resource for the consumer to verify the board certification of its members; and

(7) the organization has the ability to provide a full explanation of its certification process and membership upon request by the Texas Medical Board.

As you can see by the red #'s 2 and 3, any doctor who was certified by ABPS before 2010 could. It's very few physicians actually. And they did this because they decided there were so few physicians it was worth it rather than fight the legal battle.
You cannot go get ABPS today and advertise yourself as "board certified". Not happening.

 

[SKaminski]

Except it's not that easy.
Yes, there was a loophole back in 2009.


As you can see by the red #'s 2 and 3, any doctor who was certified by ABPS before 2010 could. It's very few physicians actually. And they did this because they decided there were so few physicians it was worth it rather than fight the legal battle.
You cannot go get ABPS today and advertise yourself as "board certified". Not happening.

I'm sorry, but I still believe that you're wrong. Number 3 is separate from number 2, as seen by the 'or' between 2 and 3.

If you look at 3:

the TMB determines that the physician-based certifying organization that conferred the certification has certification requirements that are substantially equivalent to the requirements of the ABMS or the BOS existing at the time of application to the medical board.

And then Boards Recognized for Purposes of Advertisement Only - List of approved certifying boards.

The ABPS is explicitly listed as a list of approved certifying boards.

If you were to get ABPS today, you would be considered board certified by the TBM.

And, if you don't believe my line of reasoning, look at several messages given out by Emergency Medicine organizations:

President's Message: Texas Medical Board Blows Its Big Chance

Howard Blumstein, MD, AAEM President, comments on a recent decision in Texas regarding emergency medicine certification.

www.medscape.com

They don't mention "certified before 2010".

Regardless, I will go ahead and directly email ABPS and ask them "If i were board certified by ABPS in EM today, would i be able to advertise myself as Board Certified in EM in Texas?" and once i hear back i'll return here with a definitive response.

 

[VA Hopeful Dr]

This has been brought up before.
There aren't enough surgeons for every hospital. There aren't enough intensivists. There's not enough GI.
Except for emergency, they aren't using IM/FP boarded people to fill those roles. Even at the shops where the hospitalists take "care" of people, they don't call themselves ICU docs. And it is expected that their level of care is less than that of an ICU doc, inasmuch as the "real sick" ones get transferred to other ICUs.

Yes, there are the very, very rural shops where FP still does OB, and scopes, and whatnot. But it's incredibly rare.

Other fields seem to keep the creep of untrained people out of theirs. EM is different. PM&R is much newer as a speciality board, but FP/IM docs aren't doing that simply because 'it hasn't been a specialty that long".

Honestly I'm not entirely sure what PM&R does, I would bet that's part of it. Plus from what a quick Google search revealed, a fair bit of what they do most PCPs already do if not with quite as extensive a tool box (MSK issues and working with disabled patients).

Every field has their encroachments. Midlevels for all of us. Anesthesiology has the dentists moving in. Ortho has the podiatrists. Ophtho has the optometrists. PM&R has the PT/OTs. Psychiatry has the psychologists. Its a very old story for everyone. And SDN aside, I would bet you that the number of FPs practicing (both currently and training to practice) in the ED is going down over time. In the 10 years I've been a doctor, I haven't met an FP younger than 50 working in the ED unless it was, as you say, very rural or the VA. Maybe the occasional fast track only (I was offered that job right out of residency - I declined).

 

[deleted109597]

And, if you don't believe my line of reasoning, look at several messages given out by Emergency Medicine organizations:

President's Message: Texas Medical Board Blows Its Big Chance

Howard Blumstein, MD, AAEM President, comments on a recent decision in Texas regarding emergency medicine certification.

www.medscape.com

They don't mention "certified before 2010".

Regardless, I will go ahead and directly email ABPS and ask them "If i were board certified by ABPS in EM today, would i be able to advertise myself as Board Certified in EM in Texas?" and once i hear back i'll return here with a definitive response.

Feel free, but you're wrong. And they'll tell you.
Also, realize that article by Blumstein was in 2010. Which is why it doesn't mention "today".

Adopted Rules Title 22

texashistory.unt.edu

 

[VA Hopeful Dr]

Except it's not that easy.
Yes, there was a loophole back in 2009.


As you can see by the red #'s 2 and 3, any doctor who was certified by ABPS before 2010 could. It's very few physicians actually. And they did this because they decided there were so few physicians it was worth it rather than fight the legal battle.
You cannot go get ABPS today and advertise yourself as "board certified". Not happening.

I hate to say this, but they're right.

Texas Medical Board

www.tmb.state.tx.us

According to the new rules, a physician may use the term "board certified" in any advertising for his or her practice if:

1. the specialty board that conferred the certification and the certifying organization is:
   1. a member board of the American Board of Medical Specialties (ABMS),
   2. a member board of the American Osteopathic Association Bureau of Osteopathic Specialists (BOS), or
   3. is the American Board of Oral and Maxillofacial Surgery;
2. a physician holds a certification that was granted prior to September 1, 2010, and whose certifying board was approved by the medical board for advertising purposes prior to September 1, 2010, or
3. the TMB determines that the physician-based certifying organization that conferred the certification has certification requirements that are substantially equivalent to the requirements of the ABMS or the BOS existing at the time of application to the medical board.

To qualify under Option 3, above, physicians must submit an application to a committee of the TMB and demonstrate that:

(1) the organization requires all physicians who are seeking certification to successfully pass a written or an oral examination or both, which tests the applicant's knowledge and skills in the specialty or subspecialty area of medicine. All or part of the examination may be delegated to a testing organization. All examinations require a psychometric evaluation for validation;

(2) the organization has written proof of a determination by the Internal Revenue Service that the certifying board is tax exempt under the Internal Revenue Code pursuant to Section 501(c);

(3) the organization has a permanent headquarters and staff;

(4) the organization has at least 100 duly licensed members, fellows, diplomates, or certificate holders from at least one-third of the states;

(5) the organization requires all physicians who are seeking certification to have successfully completed postgraduate training that is accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association and that provides substantial and identifiable supervised training of comprehensive scope in the specialty or subspecialty certified and the organization utilizes appropriate peer review;

(6) the organization provides an online resource for the consumer to verify the board certification of its members; and

(7) the organization has the ability to provide a full explanation of its certification process and membership upon request by the Texas Medical Board.

• Board Certification Advertising Application - Application to have a certifying board recognized for purposes of advertising.
• Boards Recognized for Purposes of Advertisement Only - List of approved certifying boards.

If you click that last link, you get this:

Certifying Boards Recognized for Purposes of Advertisement Only
Name and Date of Recognition by the Texas Medical Board
1. American Board of Facial Plastic and Reconstructive Surgery; June 15, 2011, Renewed June 10, 2016
2. American Board of Cosmetic Surgery; April 12, 2013, Renewed June 15, 2018
3. American Board of Pain Medicine; August 29, 2014; Renewed June 14, 2019
4. American Board of Interventional Pain Physicians; June 17, 2016
5. American Board of Electrodiagnostic Medicine; December 2, 2016
6. American Board of Urgent Care Medicine; June 16, 2017
7. American Board of Physician Specialties - Emergency Medicine; October 2009, Renewed March 2, 2018

 

[deleted109597]

It's this part that's important.

certification requirements that are substantially equivalent to the requirements of the ABMS or the BOS existing at the time of application to the medical board.

You see, ABPS boards will count FM residencies. But TMB won't, because FM residency isn't substantially equivalent, nor does it require oral boards or other key points.
This is like arguing with non-medical people on facebook. I'm on the board for TCEP. I know the rules. Reading internet sources does not make one an expert.

 

[deleted109597]

Even still, it's irrelevant if they can or cannot advertise themselves as BC.
Because CMGs will hire them anyway, regardless of BC/BE status. You can see the ads. And not just in rural towns. In my city, there's a residency (run by a CMG). The main competitor hospital medical director is a graduated FM resident that I supervised in residency. They simply don't care when they can pay less trained people less money (see NPs).
If you want to compare yourselves to NPs, feel free.

 

[VA Hopeful Dr]

It's this part that's important.

You see, ABPS boards will count FM residencies. But TMB won't, because FM residency isn't substantially equivalent, nor does it require oral boards or other key points.
This is like arguing with non-medical people on facebook. I'm on the board for TCEP. I know the rules. Reading internet sources does not make one an expert.

I'm not claiming to be an expert, I'm literally just copy-pasting what the TMB website says about it. The ABPS (which if you'll recall from my post not 6 hours old I also think is a garbage BC-granting body) EM BC does require more than just graduating from an FM program.

 

[VA Hopeful Dr]

Even still, it's irrelevant if they can or cannot advertise themselves as BC.
Because CMGs will hire them anyway, regardless of BC/BE status. You can see the ads. And not just in rural towns. In my city, there's a residency (run by a CMG). The main competitor hospital medical director is a graduated FM resident that I supervised in residency. They simply don't care when they can pay less trained people less money (see NPs).
If you want to compare yourselves to NPs, feel free.

That is one of my concerns - using us to pay everyone wanting to work in the ED less. I wouldn't be surprised to see the same thing in hospital medicine in the near future.

 

[deleted109597]

I'm not claiming to be an expert, I'm literally just copy-pasting what the TMB website says about it. The ABPS (which if you'll recall from my post not 6 hours old I also think is a garbage BC-granting body) EM BC does require more than just graduating from an FM program.

Correct. It is essentially a practice track. 7000 hours over 5 (or more) years. Unfortunately, we all know that teaching yourself on the job is not the gold standard.
Currently there are 175 EM doctors in Texas certified this way. Unless some of them have retired. It's the same 175 that were essentially grandfathered by the TMB in 2009.

 

[EM_Rebuilder]

The only physician who is qualified to work in an emergency department is one who has completed an Emergency Medicine residency program and takes and passes the written and oral boards. Anyone else is a lower tiered provider.

Not saying you can’t do it, but this is a factual statement and can not be argued with.

I can go do some surgery, doesn’t make me a general surgeon. Just because you work in an ER or take some sham boards or some states ‘sow you to call yourself BC’, it does not make you an Emergency Physician.....

 

[VA Hopeful Dr]

The only physician who is qualified to work in an emergency department is one who has completed an Emergency Medicine residency program and takes and passes the written and oral boards. Anyone else is a lower tiered provider.

Not saying you can’t do it, but this is a factual statement and can not be argued with.

I can go do some surgery, doesn’t make me a general surgeon. Just because you work in an ER or take some sham boards or some states ‘sow you to call yourself BC’, it does not make you an Emergency Physician.....

Agree with the second part. If you trained in anything other than EM, you shouldn't call yourself an emergency physician. Hard stop.

As for the first part, I would bet the FPs who have been working full time in the ED since the late 70s/early 80s are pretty much equivalent to the EM grads who started at the same time.

 

[deleted109597]

Agree with the second part. If you trained in anything other than EM, you shouldn't call yourself an emergency physician. Hard stop.

As for the first part, I would bet the FPs who have been working full time in the ED since the late 70s/early 80s are pretty much equivalent to the EM grads who started at the same time.

The ABEM practice track ended in 1988. Because there were people doing it, just like every other prior board certification, you had to have some means to let those who had been doing it become board certified. The ones who didn't simply chose not to (or couldn't pass the boards).
We are currently having the same issue with the EMS subspecialty board. 60% failure rates if you didn't do a fellowship, because teaching yourself on the job isn't the best way to know the information.

 

[Kach]

Of course there are "opportunities."

The CMGs will hire anyone.

Cool, go there and be a warm body.

You realize how ridiculous this sounds right? Watching YouTube videos on huge topics of emergency medicine that we spent 3 or 4 years training on that you you haven't been exposed to since you feigned interest on whatever rotation you were on during ms3.

Gotcha. 😉.

 

[Kach]

There are myriad opportunities to be a cosmetic doctor doing botox as well.
Doesn't make it a good idea always.
If you don't train in EM, you won't be as proficient. All of us have work with non-EM boarded doctors. We aren't making things up.

Good point!

 

[Apollyon]

Practice track ended 1989. That's all.

 

[Fox800]

The problem is that none of these new residency grads are going to work at some rural hospital for 150/hr.

No sense in going somewhere and making the same as a specialty RN on overtime, or an MLP.

 

[Airborne Flt Doc]

The only physician who is qualified to work in an emergency department is one who has completed an Emergency Medicine residency program and takes and passes the written and oral boards. Anyone else is a lower tiered provider.

Not saying you can’t do it, but this is a factual statement and can not be argued with.

I can go do some surgery, doesn’t make me a general surgeon. Just because you work in an ER or take some sham boards or some states ‘sow you to call yourself BC’, it does not make you an Emergency Physician.....

Simply....Untrue

ABPS has written & oral Boards. Many collegial, professional mentors have helped train primary care docs who made transition to ER just like they mentor new ER residency trained docs & NPs & PAs. We don’t even hire new ER residents in our group without 2-3 years out the residency setting in a 45k volume ER with a 25k volume attached Pediatric ER. Many docs want to work with our SDG & the only fired docs in 2 years have been 2 ER trained that don’t seem to recognize there own limitations, don’t seem to keep up with CME, don’t know when to ask for help, don’t work well with others & are to arrogant to staff.

 

[Fox800]

Simply....Untrue

ABPS has written & oral Boards. Many collegial, professional mentors have helped train primary care docs who made transition to ER just like they mentor new ER residency trained docs & NPs & PAs. We don’t even hire new ER residents in our group without 2-3 years out the residency setting in a 45k volume ER with a 25k volume attached Pediatric ER. Many docs want to work with our SDG & the only fired docs in 2 years have been 2 ER trained that don’t seem to recognize there own limitations, don’t seem to keep up with CME, don’t know when to ask for help, don’t work well with others & are to arrogant to staff.

Deep breath.

Docs like you are a detriment to our profession. We've had EM training programs for decades now. The subtle smugness doesn't help your case.

The end.

 

[GonnaBeADoc2222]

Simply....Untrue

ABPS has written & oral Boards. Many collegial, professional mentors have helped train primary care docs who made transition to ER just like they mentor new ER residency trained docs & NPs & PAs. We don’t even hire new ER residents in our group without 2-3 years out the residency setting in a 45k volume ER with a 25k volume attached Pediatric ER. Many docs want to work with our SDG & the only fired docs in 2 years have been 2 ER trained that don’t seem to recognize there own limitations, don’t seem to keep up with CME, don’t know when to ask for help, don’t work well with others & are to arrogant to staff.

Lol you hire people who transitioned from IM/FM but don't hire new residency trained grads.

That's pretty rich.

 

[Airborne Flt Doc]

Deep breath.

Docs like you are a detriment to our profession. We've had EM training programs for decades now. The subtle smugness doesn't help your case.

The end.

My post is not for me to practice debate or win any case. It is to disseminate the truth & protect the docs from those spreading Fake News. Facts have been presented & I want to help those who learned they loved EM more later in residency or practice.

I could be doing Conceirge Medicine or own a MedSpa, but as the good Lord would have it, for now, I serve humanity in the ER & love my job & the team I work with.

This was my first way to give back wisdom I wish I would have known earlier.

 

[TooMuchResearch]

See my post above about nurses bagging patients for 30 minutes while waiting for a CRNA to drive in from home. We replaced those non-EM trained mostly old guys. They also have stories about transferring pediatric lacerations and anything needing procedural sedation.

Agree with the second part. If you trained in anything other than EM, you shouldn't call yourself an emergency physician. Hard stop.

As for the first part, I would bet the FPs who have been working full time in the ED since the late 70s/early 80s are pretty much equivalent to the EM grads who started at the same time.

 

[VA Hopeful Dr]

The ABEM practice track ended in 1988. Because there were people doing it, just like every other prior board certification, you had to have some means to let those who had been doing it become board certified. The ones who didn't simply chose not to (or couldn't pass the boards).
We are currently having the same issue with the EMS subspecialty board. 60% failure rates if you didn't do a fellowship, because teaching yourself on the job isn't the best way to know the information.

What does that have to do with what I posted?

 

[VA Hopeful Dr]

See my post above about nurses bagging patients for 30 minutes while waiting for a CRNA to drive in from home. We replaced those non-EM trained mostly old guys. They also have stories about transferring pediatric lacerations and anything needing procedural sedation.

How do they compare with the equally old but EM trained guys?

 

[BoardingDoc]

My post is not for me to practice debate or win any case. It is to disseminate the truth & protect the docs from those spreading Fake News. Facts have been presented & I want to help those who learned they loved EM more later in residency or practice.

I could be doing Conceirge Medicine or own a MedSpa, but as the good Lord would have it, for now, I serve humanity in the ER & love my job & the team I work with.

This was my first way to give back wisdom I wish I would have known earlier.

Well, at least the smugness isn't subtle anymore.

 

[TooMuchResearch]

The older EM trained folks at my residency could do critical procedures. We don't have anyone quite that, um, seasoned in my part of our group.

How do they compare with the equally old but EM trained guys?

 

[VA Hopeful Dr]

The older EM trained folks at my residency could do critical procedures. We don't have anyone quite that, um, seasoned in my part of our group.

Heh, fair enough.

I guess I'm thinking back to residency where the EM group had a couple of FPs who had been doing EM full time since the early 80s. They did the same procedures as the EM-trained doctors (who were younger but only be about 10 years), I don't recall any of them ever having to call for help. I don't recall seeing anything different in terms of outcomes from any of the patients we admitted.

 

[deleted109597]

What does that have to do with what I posted?

Those older guys could have been boarded. They chose not to. That is, had they truly had been doing it since 70s/80s like you said.
There was a path for the people doing it before the residencies started (1979). But it stayed open just at 10 years.

 

[VA Hopeful Dr]

Those older guys could have been boarded. They chose not to. That is, had they truly had been doing it since 70s/80s like you said.
There was a path for the people doing it before the residencies started (1979). But it stayed open just at 10 years.

I don't really care if they were or were not boarded (I have no idea if they were or were not) as its not really germane to the point I was making.

 

[deleted109597]

I don't really care if they were or were not boarded (I have no idea if they were or were not) as its not really germane to the point I was making.

Then please tell me what your point was. Because you said

As for the first part, I would bet the FPs who have been working full time in the ED since the late 70s/early 80s are pretty much equivalent to the EM grads who started at the same time.

Which means they started at the time the specialty started. Which means they've been doing it for 40 years (very, very few are still working that long). Which means they're probably at least 2 decades behind current practice. And not really relevant to new FM grads coming out and starting working in EDs and then attempting to get a workaround fake board.

 

[namethatsmell]

Ohhh look, this question/thread again.

Sorry it took me so long to chime in, I was busy watching reruns of Chicago Hope to brush up on pediatric cardiac surgery.

I start up my new gig doing kiddie hearts in a few weeks and I've been working hard for the last month to prepare.

I've been spending 2 hours a day, 3 days a week reviewing relevant cases from Grey's, House (and of course the great Chicago Hope) and crushing Wikipedia. It's been hard work, but between these resources and the pediatric experience and heart experience I've gotten in EM, I see this being a smooth transition.

 

[GonnaBeADoc2222]

If you're watching Grey's you might as well add some neurosurg moonlighting in there too

 

[Fox800]

I did a few lac repairs on faces that looked good, so I'm basically a plastic surgeon.

I tinkered with a ventilator and started someone on three vasopressors, so I'm basically an intensivist.

 

[VA Hopeful Dr]

Then please tell me what your point was. Because you said

Which means they started at the time the specialty started. Which means they've been doing it for 40 years (very, very few are still working that long). Which means they're probably at least 2 decades behind current practice. And not really relevant to new FM grads coming out and starting working in EDs and then attempting to get a workaround fake board.

My point was in response to this:

The only physician who is qualified to work in an emergency department is one who has completed an Emergency Medicine residency program and takes and passes the written and oral boards. Anyone else is a lower tiered provider.

Not saying you can’t do it, but this is a factual statement and can not be argued with.

I can go do some surgery, doesn’t make me a general surgeon. Just because you work in an ER or take some sham boards or some states ‘sow you to call yourself BC’, it does not make you an Emergency Physician.....

Also, and I get tired of saying this, I also think the ABPS BC is nonsense.

 

[Fox800]

The ABPS is a joke, and most hospitals won't accept it, because everyone knows it's a short-cut and a work-around.

 

[thegenius]

If you're watching Grey's you might as well add some neurosurg moonlighting in there too

And intermittently hooking up with hot nurses and hot docs, then accidentally get one pregnant. Then have a paternity battle. Then one morning say “S*%t, I’m late for my tetralogy surgery!!!” Throw on some clothes, rush into the hospital 1.5 hrs late, still manage to do the surgery, then tell the other hot nurse not to give you “the look” during surgery because it’s distracting.

 

[Siggy]

Agreed.

Similarly, while our IM colleagues are very adamant about adequate BP control, I don't think you can properly run an ED without some sense of comfort with discharging home an asymptomatic hypertensive individual to 180s. Our IM colleagues who rotate through the ED routinely want to treat these BPs with IV medications, which again, is not how EM is practiced. Similar situation with high blood sugars.

To be fair... that's not how IM is practiced either and I delight in discontinuing PRN hydralazine orders on patients who end up in my unit. That said, it's more about getting the nurses to STOP FRICKING CALLING EVERY 5 SECONDS BECAUSE THEY SWEAR THE PATIENT IS GOING TO STROKE OUT ANY SECOND NOW ::breaths out:: because the SBP is >160.

If I ever find the nursing instructor who started the SBP >160 means the patient will stroke out or the one who started the "potassium of 3.4 is a critial value" trope...

 

[MedicineZ0Z]

See my post above about nurses bagging patients for 30 minutes while waiting for a CRNA to drive in from home. We replaced those non-EM trained mostly old guys. They also have stories about transferring pediatric lacerations and anything needing procedural sedation.

That's very unusual. Most non-EM docs working in an ED are comfortable with the vast majority of airways. Same with putting in lines etc. You need like 70-80 tubes + a good airway course to become proficient with airways. Lines? Like 10. Chest tubes? A couple tops. Reductions, sure... but they're all auto-ortho consults anyway in academic centers so its not like EM guys are doing it in those places.

 

[hoot504]

That's very unusual. Most non-EM docs working in an ED are comfortable with the vast majority of airways. Same with putting in lines etc. You need like 70-80 tubes + a good airway course to become proficient with airways. Lines? Like 10. Chest tubes? A couple tops. Reductions, sure... but they're all auto-ortho consults anyway in academic centers so its not like EM guys are doing it in those places.

Is this a troll post? I honestly can't tell.

 

[MedicineZ0Z]

Is this a troll post? I honestly can't tell.

Feel free to correct me. We have residents placing unsupervised lines after doing 5(sometimes less). And there's literature behind # of tubes.

EM training's value is in the breadth of exposure and mentality training. The notion that non-EM boarded guys routinely sit around waiting for a CRNA is nonsense.

 

[thegenius]

That's very unusual. Most non-EM docs working in an ED are comfortable with the vast majority of airways. Same with putting in lines etc. You need like 70-80 tubes + a good airway course to become proficient with airways. Lines? Like 10. Chest tubes? A couple tops. Reductions, sure... but they're all auto-ortho consults anyway in academic centers so its not like EM guys are doing it in those places.

I’d say the right amount of training intubating, central lines, ortho reductions, thoracostomies, paracentesis, thoracentesis, lumbar puncture, I&D, FB removal in cornea, pericardiocentesis, lateral canthotomy, conscious sedation, deep sedation, transvenous pacing, CPR, and about 20 other procedures is well defined in the EM RRC requirements.

Not just “doing about 10.”

If you want to do ER, one should be formally trained in ER. You can’t do ER if you can only do 1/4 or even 1/2 of the things needed to be an ER doc.

 

[Lexdiamondz]

That's very unusual. Most non-EM docs working in an ED are comfortable with the vast majority of airways. Same with putting in lines etc. You need like 70-80 tubes + a good airway course to become proficient with airways. Lines? Like 10. Chest tubes? A couple tops. Reductions, sure... but they're all auto-ortho consults anyway in academic centers so its not like EM guys are doing it in those places.

This isn't true in the least.

I know IM trained guys who grandfathered into EM 30 years ago in continuous practice who cannot tubed and aren't credentialed to supervise residents because of it.

You're an intern in September - how would you possibly know what most non-BCEM docs are comfortable with? The reality of what actually goes down out there would probably terrify you.