Can I practice EM after IM residency?

[MEL9000]

I am an internal medicine PGY2, and I am really enjoying my emergency medicine rotation right now. Do emergency departments ever hire IM trained physicians? Are there fellowship opportunities after IM residency to become EM certified?

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[InternistDO]

There are no fellowship opportunities, short of going back to residency for EM. The "fellowship" that FM doctors talk about does not grant you ABEM/ABOEM board certification and is unlikely to get you a big city EM job.

Many understaffed rural or suburban EDs will hire FM or IM grads for EM work. Some require "ER experience", others don't. It's likely over the next decade or so these opportunities will dwindle as EM grows as a specialty but who really knows. I think the last ACEP compensation report found that about 40% of advertised EM jobs were open to FM/IM doctors, though obviously its very location dependent.

 

[Apollyon]

I am an internal medicine PGY2, and I am really enjoying my emergency medicine rotation right now. Do emergency departments ever hire IM trained physicians? Are there fellowship opportunities after IM residency to become EM certified?

So, you signed up for SDN nearly a year ago, and this is your first post?

So, to your question: 1: ever? Yes, occasionally 2. No.

If you like EM, do an EM residency. IM residency would make you good at the IM type patients, if you can get out of the mindset of "it probably isn't, so we won't chase it" and change to "it probably isn't, but we have to rule it out". But, you will get minimal to zero exposure in your residency for peds, trauma, OB/GYN, psych, or airway management. The FM people can say, "We do 90% or 95% of what you do", but EM is there for the 5% to 10% that IS us. Your worst day is my best day. I don't want to see patients again. You are being trained in linear treatment of a patient panel.

Places that would hire a freshly minted IM doc to work in the ED are, very likely, desperate/in financial trouble/dumpster fires. You would not be the first choice - at all. If/when you screw up, you will be held to the same standard, and you will lose.

 

[namethatsmell]

Places that would hire a freshly minted IM doc to work in the ED are, very likely, desperate/in financial trouble/dumpster fires. You would not be the first choice - at all. If/when you screw up, you will be held to the same standard, and you will lose.

This is the most useful and honest advice you'll get. In IM, you'll get minimal to no exposure in things like ob/peds/ortho which are major facets of EM. Will you feel comfortable with having no training in the knowledge/skills/abilities needed to care for ~10-30% of your daily ED patients?

Search the forums as this type of question (FM/IM trained docs working in the ED) has been covered extensively.

Mods can we close this puppy down before the flames grow?

 

[RoyBasch]

IM residency would make you good at the IM type patients, if you can get out of the mindset of "it probably isn't, so we won't chase it" and change to "it probably isn't, but we have to rule it out".

This is awesome! I'm going to steal it.

Back to the OP's question:

Yes options exist, I get emails every day for ER jobs in remote towns and rural areas that say they will accept FM/IM boarded. You will not be able to get a job in a large or medium size city without being ABEM or ABEM eligible anymore.

The serious question you have to ask yourself is just because you can get this job, do you really want it?

I estimate about 80% of EM is internal medicine: chest pain, abdominal pain, syncope, dyspnea, etc.

The other 20% is peds, trauma, gyn, surgery, anesthesia, ophtho, ENT, dentistry. As a medicine resident you have virtually no training in those areas. Assuming you see 20 patients a shift, thats 4 patients EVERY shift whose lives are in your hands that you have very little training to manage.

What are you going to do on shift when you see a febrile 3 month old? What are you going to do when you see a 8 week pregnant patient with vaginal bleeding? What are you going to do about a patient who needs to be emergently intubated? What are you going to do about a patient with a red eye? What are you going to do about a patient with uncontrolled epistaxis?

Some of these patients are going to be fine: The 3 month old has ultimately a self resolving viral infection, the pregnant patient has a SAB whose clinical course cannot be altered, the airway patient has...an easy airway. The red eye is viral conjunctivitis. The epistaxis will resolve with simple pressure.

But what if...That's not true.

The 3 month old has a serious bacterial infection with sepsis, can you recognize and treat it? The vag bleeder is hemorrhaging significantly and needs operative management, can you recognize that? The airway is...not easy, how can you deal with a difficult or failed airway? The red eye is actually acute angle closure glaucoma, can you diagnose and treat that? The epistaxis is not stopping with pressure, what is the next move?

If you don't know the answer to these and a thousand other similar patients/situations, you are not capable of being an ER physician who can meet standard of care.

Your answer may be: "Well I'll just call a consult of specialist X, Y, Z..."

However, the types of hospitals that will hire an internist instead of a ER physician to work in the ER typically have very poor/sparse specialist coverage. There is nobody to answer your call. The transfer is 100 miles and 2 hours away.

It's very ironic, but the types of hospitals that have the lowest standards for their ER staff would probably benefit from having the best/most well trained ER physicians.

 

[thecalccobra]

This is awesome! I'm going to steal it.

Back to the OP's question:

Yes options exist, I get emails every day for ER jobs in remote towns and rural areas that say they will accept FM/IM boarded. You will not be able to get a job in a large or medium size city without being ABEM or ABEM eligible anymore.

The serious question you have to ask yourself is just because you can get this job, do you really want it?

I estimate about 80% of EM is internal medicine: chest pain, abdominal pain, syncope, dyspnea, etc.

The other 20% is peds, trauma, gyn, surgery, anesthesia, ophtho, ENT, dentistry. As a medicine resident you have virtually no training in those areas. Assuming you see 20 patients a shift, thats 4 patients EVERY shift whose lives are in your hands that you have very little training to manage.

What are you going to do on shift when you see a febrile 3 month old? What are you going to do when you see a 8 week pregnant patient with vaginal bleeding? What are you going to do about a patient who needs to be emergently intubated? What are you going to do about a patient with a red eye? What are you going to do about a patient with uncontrolled epistaxis?

Some of these patients are going to be fine: The 3 month old has ultimately a self resolving viral infection, the pregnant patient has a SAB whose clinical course cannot be altered, the airway patient has...an easy airway. The red eye is viral conjunctivitis. The epistaxis will resolve with simple pressure.

But what if...That's not true.

The 3 month old has a serious bacterial infection with sepsis, can you recognize and treat it? The vag bleeder is hemorrhaging significantly and needs operative management, can you recognize that? The airway is...not easy, how can you deal with a difficult or failed airway? The red eye is actually acute angle closure glaucoma, can you diagnose and treat that? The epistaxis is not stopping with pressure, what is the next move?

If you don't know the answer to these and a thousand other similar patients/situations, you are not capable of being an ER physician who can meet standard of care.

Your answer may be: "Well I'll just call a consult of specialist X, Y, Z..."

However, the types of hospitals that will hire an internist instead of a ER physician to work in the ER typically have very poor/sparse specialist coverage. There is nobody to answer your call. The transfer is 100 miles and 2 hours away.

It's very ironic, but the types of hospitals that have the lowest standards for their ER staff would probably benefit from having the best/most well trained ER physicians.

Post of the month. Very well said.

 

[Birdstrike]

I am an internal medicine PGY2, and I am really enjoying my emergency medicine rotation right now. Do emergency departments ever hire IM trained physicians? Are there fellowship opportunities after IM residency to become EM certified?

Don't attempt to do this. Stay in IM and tease out what it is about EM you like (whether procedures, emergencies or problem-focused nature, etc) and choose an IM fellowship with some of those qualities. Don't expect to be able to do IM then be an EP. Either do what I describe above, or if you're hell bent on EM, transfer to an EM residency (and then do an EM fellowship after).

 

[deleted109597]

Mods can we close this puppy down before the flames grow?

If and when they happen. This is good feedback. Closing it pushes it onto the second page, where it will languish.

 

[GonnaBeADoc2222]

Oh man. This again, huh?

 

[VA Hopeful Dr]

Oh man. This again, huh?

So should I go do an FM-based EM fellowship and be just as good as EM-residency trained doctors or just keep sending all my BPs of 160/95 to the ED because they're going to have a stroke any minute?

I'm sure I can hit some more pet peeves while I'm at it

 

[Vandalia]

This certainly isn't my place since I haven't donated to this site, but perhaps we can have some sort of sign-in screen where new posters have to acknowledge:

1) All physician forums: NO, we won't give you any medical advice. Really. Seriously. No.
2) EM: If you want to practice EM do an EM residency.
3) FM: Yes, you can do OB, but do you really want to?
4) IM: Yes, med students a hospitalist gig sounds like a great job, until you actually complete an IM residency and realize that is your life forever.
5) Surgery: You might match with your scores, then again, you might not.

I am sure there are others who can do much better than that.

 

[Zebra Hunter]

I’ve considered sh*tposting to other forums about whether anyone would hire me in their field.

“Hey guys, I’m an EM attending who loves the critical patients. I was wondering if any hospital would hire me to work as an ICU doc.”

“Hey bros, I’m an EM attending who is really good with orthopedic emergencies. I was wondering if any ortho group would hire me on to take care of things like complicated reductions, OR washouts, and what not.”

“Hey dudes, I’m an EM attending who has a penis. Do you think any urology group would hire me?”

 

[Birdstrike]

I’ve considered sh*tposting to other forums about whether anyone would hire me in their field.

“Hey guys, I’m an EM attending who loves the critical patients. I was wondering if any hospital would hire me to work as an ICU doc.”

“Hey bros, I’m an EM attending who is really good with orthopedic emergencies. I was wondering if any ortho group would hire me on to take care of things like complicated reductions, OR washouts, and what not.”

“Hey dudes, I’m an EM attending who has a penis. Do you think any urology group would hire me?”

Or, "I made a baby, will you hire me as an ob-gynie?

 

[enalli]

I’ve considered sh*tposting to other forums about whether anyone would hire me in their field.

“Hey guys, I’m an EM attending who loves the critical patients. I was wondering if any hospital would hire me to work as an ICU doc.”

“Hey bros, I’m an EM attending who is really good with orthopedic emergencies. I was wondering if any ortho group would hire me on to take care of things like complicated reductions, OR washouts, and what not.”

“Hey dudes, I’m an EM attending who has a penis. Do you think any urology group would hire me?”

I get what you're saying, but in November of 2018, the answer to OP's question is, for better or for worse, yes.

Is it ideal for the specialty or for patient care? No; I would much prefer that all EDs were staffed by EM residency-trained physicians. But honestly, I would rather have an IM residency-trained physician see my family at a rural ED than an NP.

 

[GonnaBeADoc2222]

I get what you're saying, but in November of 2018, the answer to OP's question is, for better or for worse, yes.

Is it ideal for the specialty or for patient care? No; I would much prefer that all EDs were staffed by EM residency-trained physicians. But honestly, I would rather have an IM residency-trained physician see my family at a rural ED than an NP.

Meh.

Can you? Sure. Should you? I think we all know the answer to that. As someone who works with some non-EM trained folks, it gets pretty old after awhile having to bail people out of airway emergencies and get vascular access for them seemingly all the time because they never bothered to learn ultrasound.

Train for the job you want.

Do you feel cool managing the following after IM residency by yourself: Preecclampsia, dislocated shoulders/hips/elbows, polytrauma, peritonsillar abscess, 2 yo with facial laceration that requires sedation for repair, intracranial hemorrhage, epistaxis, difficult IV access, bronchiolitis in a 6 mo, chest tube placement, difficult airway, fever of unknown origin in a 1 yo? I hope so, cause this is our ROUTINE every day.

Also are you ready both mentally and technically to spring into action to perform a circothyrotomy? A peri-mortem c-section? A blind pericardiocentesis? These are the procedures which maybe happen once every few years. EM residency trains you for this possibility. Don't you think the patient is owed this?

 

[killerleaf]

At a local VA, (that is 4 blocks from a Level 1 trauma center, so they don't get those to begin with, and the ED is low volume anyway) in addition to the EM docs, they also have a hospitalist assigned to the ED. They are the ones who get the people that they feel are going to get admitted anyway. It works well, for them...but I can see where it would not be a good system for other places.

 

[TheComebacKid]

The FM people can say, "We do 90% or 95% of what you do", but EM is there for the 5% to 10% that IS us.

While I agree with pretty much the majority of your post, these numbers to me seem off.

I would argue that nothing people learn about in FM residency is applicable to the emergency aspects of our job. Furthermore, while FM individuals are adequately trained in evaluating back pain, the whole paradigm of FM is not predicated on emergent evaluation of back pain. I would venture to guess a FM physician is more likely to think "lumbar strain" first instead of "ruptured AAA" or "epidural abscess" because that's what the training model emphasizes.

This is not to take away anything from FM physicians. As someone training in EM, I don't think I have adequate training at managing chronic medical conditions that are routinely seen by FM and IM docs.

I estimate about 80% of EM is internal medicine: chest pain, abdominal pain, syncope, dyspnea, etc.

To re-emphasize the point above, while your statement is true, the EM workup of these presentations is very different than the IM approach. The EM mindset and approach to medicine in general that is ingrained in us during training is vastly different than how an IM physician sees these conditions. Workup of undifferentiated patients and ruling out badness is really at the crux of our specialty. IM, while it prepares you phenomenally well to tackle other important aspects of patient care, is insufficient when it comes to resuscitation, emergent procedures, etc.

 

[thegenius]

While I agree with pretty much the majority of your post, these numbers to me seem off.

I would argue that nothing people learn about in FM residency is applicable to the emergency aspects of our job. Furthermore, while FM individuals are adequately trained in evaluating back pain, the whole paradigm of FM is not predicated on emergent evaluation of back pain. I would venture to guess a FM physician is more likely to think "lumbar strain" first instead of "ruptured AAA" or "epidural abscess" because that's what the training model emphasizes.

This is not to take away anything from FM physicians. As someone training in EM, I don't think I have adequate training at managing chronic medical conditions that are routinely seen by FM and IM docs.

To re-emphasize the point above, while your statement is true, the EM workup of these presentations is very different than the IM approach. The EM mindset and approach to medicine in general that is ingrained in us during training is vastly different than how an IM physician sees these conditions. Workup of undifferentiated patients and ruling out badness is really at the crux of our specialty. IM, while it prepares you phenomenally well to tackle other important aspects of patient care, is insufficient when it comes to resuscitation, emergent procedures, etc.

Not only do I agree with this, there is empirical evidence as well. How often do we see our fellow IM colleagues, during their ER rotation, wait to get lab values and ABGs prior to treating dyspnea?

I think EM has done an excellent job in helping us recognize certain physical exam patterns, disease states, and giving us confidence to treat with very little information - which amounts to a physical exam and vitals. If someone coming in with a RR of 35, by the time I leave the room I will put in orders to treat that patient (as well as work them up). Another example...there are very few disease states in EM that require us to get an ABG prior to treatment, and I almost never order them. And I tell our hospitalists that they are welcome to order ABGs - I have already initiated treatment and an ABG won't help me per se.

 

[TheComebacKid]

Not only do I agree with this, there is empirical evidence as well. How often do we see our fellow IM colleagues, during their ER rotation, wait to get lab values and ABGs prior to treating dyspnea?

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.

Transitioning from the IM model of working up and managing a patient is very different compared to the EM approach.

 

[RustedFox]

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.

Transitioning from the IM model of working up and managing a patient is very different compared to the EM approach.

Don't. Get.
Me. Started.

 

[Apollyon]

While I agree with pretty much the majority of your post, these numbers to me seem off.

I would argue that nothing people learn about in FM residency is applicable to the emergency aspects of our job. Furthermore, while FM individuals are adequately trained in evaluating back pain, the whole paradigm of FM is not predicated on emergent evaluation of back pain. I would venture to guess a FM physician is more likely to think "lumbar strain" first instead of "ruptured AAA" or "epidural abscess" because that's what the training model emphasizes.

That's what I meant - we're there for the rare occasion where things are time dependent. With an obstructed airway, there isn't time to stand there and think. When the blood is pumping out of an arterial bleed, things happen now.

It's like why a surgeon is there for an appy - they're not there for when it is straightforward, but when it isn't, like a perf or a carcinoid or a retrocecal.

We put up with all the BS for the infrequent times when our expertise is needed.

 

[sluggs]

I am IM/CCM trained and would feel comfortable managing just about any crashing adult patient(I have broad experience with trauma, neuro, cv, Ob/gyn) and no way would I ever pretend I could do EM. There is Peds, basic ob/gyn, ORTHO, etc.... No way.
Plus it is really nice to have an ER doc see my patients before me and be able to second-guess how or her.
EM is a specialty for a reason and the training required of ER docs is required.... gotta be a jack of all trades. All my respect to them!!!

 

[Airborne Flt Doc]

I am an internal medicine PGY2, and I am really enjoying my emergency medicine rotation right now. Do emergency departments ever hire IM trained physicians? Are there fellowship opportunities after IM residency to become EM certified?

Yes, you absolutely can be successful in EM if you choose to pursue this path, get the required experience, put in the time & effort. Even NPs & PAs with far less training are working all over the country in ER. Over 50 % of the jobs in ER are available to primary care as you can see from the ACEP link below. You must go to ACEP conferences & pay extra to do the Cadaver & other procedure courses to get smart on what you may be lacking in some procedures & go to the lectures & watch the videos on the topics you may not have had with OB/GYN, Peds, Ortho, ENT. Even ER residency trained docs & experienced ER docs get scared of Peds and will have to review & go to targeted lectures/conferences on this. There are many ERs where docs will only see about 7 to 9% Peds & should be staying up to date on this too.

You will need ATLS, PALS, & likely already have ACLS.

There are also courses at AAEM conferences, the University of Maryland -Baltimore procedure courses, Hennepin in MN, EM Boot Camps & The Difficult Airway Course which I highly recommend. Critical procedure courses are also offered at different State ACEP meetings.

2018-2019 Compensation Report for Emergency Physicians - Page 2 of 3 - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

The ER you’ll likely start off at to get your experience will be rural low volume & you will have to transfer a lot the OB/GYN, Peds, Ortho & ENT anyhow. Even most well staffed ERs have to transfer out acute Opthamology cases to a University/affiliated that can have Ophthalmology on call. There are “rural ERs” that may even be just 20-45 min away from larger towns that have your transferring hospital (and Panera/Starbucks/Mall/University) especially in GA, IN, TX, TN, PA, WV.

There are places you can get ER experience and work as a “hybrid” where you work in the ER & admit that patient to yourself working as a hospitalist also. It’s not as easy a shift sometimes as straight ER , but it is a means to an end. Hopefully, you can then transfer to a higher volume 20-40k plus ER where you would have other experienced collegial ER doctors on with you, higher pay and could hire a personal scribe which makes the work in this volume so much less stressful.

Once you have 4 years of ER experience you can apply for the ABPS EM Board Certification written test & then you take the oral boards to certify the 5th year. Be sure to maintain your primary care certification because most hospitals require this.

Emergency Medicine Board Certification | ABPS

The American Board of Physician Specialties® offers board certification in emergency medicine. For information about eligibility requirements, read on.

www.abpsus.org

Critical care fellowship is another good option for experience & job security, however, as with Hospitalist jobs, lots of rounding, case management & family meetings.

Limitations will be placed on where primary care can practice EM because the hospital/ group may want EM resident trained only. However, oftentimes, the ER docs work twice as hard & get paid less in the coastal or metro ERs that have a good supply of doctors willing to get paid less. And you would not want to work for HCA/Envision or USACS anyway that has been taking over a lot of metros. Theses ERs may pay full time docs $150-$200/hr, in these areas, however, ER docs should be nearing $250-$300+ an hour. HCA/Envision Is trying to flood the market with a bunch of ER (and IM ) residency's which will drive pay down even further in the desirable areas as supply exceeds demand & needs to be considered.

Best options are to be flexible, willing to travel & get your $2400-$3600/shift & you will have more time & money than many other docs.

 

[GonnaBeADoc2222]

Yes, if you want to be a murderer you can do this.

APBS is a joke.

No self respecting EM residency trained doc is afraid of peds.

How can you do trauma, gyn, ob, peds, etc as an IM physician?

Why was this necrobumped?

Train for the job you want.

 

[Kach]

I am an internal medicine PGY2, and I am really enjoying my emergency medicine rotation right now. Do emergency departments ever hire IM trained physicians?

Yes

Are there fellowship opportunities after IM residency to become EM certified?

Yes there are plenty of opportunities. Don't even think about being influenced by these anonymous haters.

 

[GonnaBeADoc2222]

Yes there are plenty of opportunities. Don't even think about being influenced by these anonymous haters.

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.

 

[deleted109597]

Yes there are plenty of opportunities. Don't even think about being influenced by these anonymous haters.

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.

 

[Fox800]

Yes, you absolutely can be successful in EM if you choose to pursue this path, get the required experience, put in the time & effort. Even NPs & PAs with far less training are working all over the country in ER. Over 50 % of the jobs in ER are available to primary care as you can see from the ACEP link below. You must go to ACEP conferences & pay extra to do the Cadaver & other procedure courses to get smart on what you may be lacking in some procedures & go to the lectures & watch the videos on the topics you may not have had with OB/GYN, Peds, Ortho, ENT. Even ER residency trained docs & experienced ER docs get scared of Peds and will have to review & go to targeted lectures/conferences on this. There are many ERs where docs will only see about 7 to 9% Peds & should be staying up to date on this too.

You will need ATLS, PALS, & likely already have ACLS.

There are also courses at AAEM conferences, the University of Maryland -Baltimore procedure courses, Hennepin in MN, EM Boot Camps & The Difficult Airway Course which I highly recommend. Critical procedure courses are also offered at different State ACEP meetings.

2018-2019 Compensation Report for Emergency Physicians - Page 2 of 3 - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

The ER you’ll likely start off at to get your experience will be rural low volume & you will have to transfer a lot the OB/GYN, Peds, Ortho & ENT anyhow. Even most well staffed ERs have to transfer out acute Opthamology cases to a University/affiliated that can have Ophthalmology on call. There are “rural ERs” that may even be just 20-45 min away from larger towns that have your transferring hospital (and Panera/Starbucks/Mall/University) especially in GA, IN, TX, TN, PA, WV.

There are places you can get ER experience and work as a “hybrid” where you work in the ER & admit that patient to yourself working as a hospitalist also. It’s not as easy a shift sometimes as straight ER , but it is a means to an end. Hopefully, you can then transfer to a higher volume 20-40k plus ER where you would have other experienced collegial ER doctors on with you, higher pay and could hire a personal scribe which makes the work in this volume so much less stressful.

Once you have 4 years of ER experience you can apply for the ABPS EM Board Certification written test & then you take the oral boards to certify the 5th year. Be sure to maintain your primary care certification because most hospitals require this.

Emergency Medicine Board Certification | ABPS

The American Board of Physician Specialties® offers board certification in emergency medicine. For information about eligibility requirements, read on.

www.abpsus.org

Critical care fellowship is another good option for experience & job security, however, as with Hospitalist jobs, lots of rounding, case management & family meetings.

Limitations will be placed on where primary care can practice EM because the hospital/ group may want EM resident trained only. However, oftentimes, the ER docs work twice as hard & get paid less in the coastal or metro ERs that have a good supply of doctors willing to get paid less. And you would not want to work for HCA/Envision or USACS anyway that has been taking over a lot of metros. Theses ERs may pay full time docs $150-$200/hr, in these areas, however, ER docs should be nearing $250-$300+ an hour. HCA/Envision Is trying to flood the market with a bunch of ER (and IM ) residency's which will drive pay down even further in the desirable areas as supply exceeds demand & needs to be considered.

Best options are to be flexible, willing to travel & get your $2400-$3600/shift & you will have more time & money than many other docs.

Folks like you are cheapening our profession, unfortunately.

 

[Airborne Flt Doc]

Folks like you are cheapening our profession, unfortunately.

No Sir/ma’am, we are not. Actually your new ER residency trained docs signing the low pay contracts are

 

[GonnaBeADoc2222]

No Sir/ma’am, we are not. Actually your new ER residency trained docs signing the low pay contracts are

Don't think he/she was referring to "cheapening" in the sense of money. Moreso "cheapening" in the sense of value delivered to both the patient and the health system.

 

[RustedFox]

No Sir/ma’am, we are not. Actually your new ER residency trained docs signing the low pay contracts are

Ahem.

No, he's right.

You can't have an internist do a surgeon's job.
You can't have an OBGYN do an internist's job.
You can't have a nephrologist do an FP's job.
You can't have an FP do a crit.care doc's job.

So why is it *okay* that IM/FP do an EM doc's job?

Psst: Its not.

 

[VA Hopeful Dr]

Ahem.

No, he's right.

You can't have an internist do a surgeon's job.
You can't have an OBGYN do an internist's job.
You can't have a nephrologist do an FP's job.
You can't have an FP do a crit.care doc's job.

So why is it *okay* that IM/FP do an EM doc's job?

Psst: Its not.

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?

 

[RustedFox]

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?

Great post.

But, there needs to be a clear degree of autonomy between who can and should practice EM and who can't and shouldn't.

I have worked with IM and FM folks in the ER. Only ONE of them in 7 years has been "passable", and even then; they do things they shouldn't do that had a negative impact upon our department. The others? I was all-too-often asked: "Can I run this by you?" - "Can you look at this EKG?" - or (my favorite) "Can you place a central line for me?"

The EM residency expansion threads.... I think the animus behind the disdain is that the "new" residencies aren't academic, but are rather HCA sweatshops that are just looking to flood the market with low-quality grads who are indoctrinated into their grindhouse model of EM practice. I don't think there would be such outcry if say... [University of Piedmont State] went from 10 spots to 12. Its not the numbers; its the bosses.

 

[RustedFox]

Great post.

But, there needs to be a clear degree of autonomy between who can and should practice EM and who can't and shouldn't.

I have worked with IM and FM folks in the ER. Only ONE of them in 7 years has been "passable", and even then; they do things they shouldn't do that had a negative impact upon our department. The others? I was all-too-often asked: "Can I run this by you?" - "Can you look at this EKG?" - or (my favorite) "Can you place a central line for me?"

The EM residency expansion threads.... I think the animus behind the disdain is that the "new" residencies aren't academic, but are rather HCA sweatshops that are just looking to flood the market with low-quality grads who are indoctrinated into their grindhouse model of EM practice. I don't think there would be such outcry if say... [University of Piedmont State] went from 10 spots to 12. Its not the numbers; its the bosses.

Furthermore, despite people asking me every shift (sorry; gonna brag) if I can be their PMD, I say to them with a very clear tone:

"Thanks; but sorry - I'm board-certified EMERGENCY medicine. I'm not primary care at all. Don't ask me to adjust your cholesterol or diabetes meds. Chronic arthritis? I have no idea what I'm doing there. I say to my family all the time; "if you're not dying; I'm not your guy". I'm the 'chest pain, car-crash, can't breathe, fell-off-the-roof guy.'"

I have a healthy respect for FM/IM, and what I can-NOT do. Why doesn't it go the other way around? Why do so many FM/IM folks think that they can do my job ? They don't even think the way that an EP needs to think !

 

[RustedFox]

The others? I was all-too-often asked: "Can I run this by you?" - "Can you look at this EKG?" - or (my favorite) "Can you place a central line for me?"

... and as far as THIS nonsense goes... I'm happy to offer an opinion to another EP who is worth his or her salt, but when its mickey-mouse stuff, and its several times on several patients every shift, I feel like saying: "Listen; RUCK-UP! - Make your own decisions. If you can't; then get outta here."

TWICE last month, I have had to wrest a patient's care from the FP guy, place a central line, start the pressors, and get them to the ICU.

 

[Lexdiamondz]

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?

 

[Fox800]

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 hospitals are cheap. And because they’d rather keep 11,000,000 EDs open staffed with FM/IM folks and NPs than properly incentivize primary care recruitment for clinics, and ABEM boarded docs in their ED.

 

[TooMuchResearch]

Or "can you intubate this patient for me?"
We work at a couple places that used to have FP docs. The nurses have many terrible stories of bagging patients for 30+ minutes while the FP doc say in the office waiting for a CRNA to show up. Another FP guy I know "does ER" once per week. He does roughly one critical procedure every 6-9 months by his estimation and CTs every single head injury. You want him taking care of your family on his "doing ER" day? I don't.

Great post.

But, there needs to be a clear degree of autonomy between who can and should practice EM and who can't and shouldn't.

I have worked with IM and FM folks in the ER. Only ONE of them in 7 years has been "passable", and even then; they do things they shouldn't do that had a negative impact upon our department. The others? I was all-too-often asked: "Can I run this by you?" - "Can you look at this EKG?" - or (my favorite) "Can you place a central line for me?"

The EM residency expansion threads.... I think the animus behind the disdain is that the "new" residencies aren't academic, but are rather HCA sweatshops that are just looking to flood the market with low-quality grads who are indoctrinated into their grindhouse model of EM practice. I don't think there would be such outcry if say... [University of Piedmont State] went from 10 spots to 12. Its not the numbers; its the bosses.

 

[GonnaBeADoc2222]

Because hospitals are cheap. And because they’d rather keep 11,000,000 EDs open staffed with FM/IM folks and NPs than properly incentivize primary care recruitment for clinics, and ABEM boarded docs in their ED.

This.

There are PLENTY of EPs. We aren't some super rare resource. There is a LACK of hospitals that want to pay the premium for the product.

Ya sure, staff the shop with FM/IM. Most people will have equivalent outcomes. There will be some percentage that are overworked up, and exposed to radiation / drugs that they don't need. There will be a smaller percentage that are truly harmed. Just cause this number is small, does that mean it's ok? Are you ok with this "small" number even if it's you or someone you care about that's harmed?

It's like.....I wanna fly somewhere....I'd really like to fly on Emirites. It costs a lot. Alternatively I can fly there on Spirit. It's way cheaper and it'll probably get me there fine, but won't be as great a time, and probably won't be as safe.

 

[Airborne Flt Doc]

Yes, if you want to be a murderer you can do this.

APBS is a joke.

No self respecting EM residency trained doc is afraid of peds.

How can you do trauma, gyn, ob, peds, etc as an IM physician?

Why was this necrobumped?

Train for the job you want.

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

Many of your FP/IM colleagues have a lot of experience working Trauma/Ortho/OB managing and consulting these patients in the ICU/CCU/SICU.

Many military docs are FP/IM with more trauma & Peds experience than any expect

 

[hoot504]

Airborne, may I ask your background?

 

[emergentmd]

Furthermore, despite people asking me every shift (sorry; gonna brag) if I can be their PMD, I say to them with a very clear tone:

"Thanks; but sorry - I'm board-certified EMERGENCY medicine. I'm not primary care at all. Don't ask me to adjust your cholesterol or diabetes meds. Chronic arthritis? I have no idea what I'm doing there. I say to my family all the time; "if you're not dying; I'm not your guy". I'm the 'chest pain, car-crash, can't breathe, fell-off-the-roof guy.'"

I have a healthy respect for FM/IM, and what I can-NOT do. Why doesn't it go the other way around? Why do so many FM/IM folks think that they can do my job ? They don't even think the way that an EP needs to think !

Follow the money. This is all that matters.

If FM/IM made twice as much as hour as EM docs, I and many other EM docs would be opening up a outpt clinic tomorrow. I am confident that I could do IM/FM pretty quickly. Likely somewhat poor early on but in a year, I would be up to speed.

That is why I see EM docs open up Medi Spa, infusion clinics, etc.

 

[VA Hopeful Dr]

This.

There are PLENTY of EPs. We aren't some super rare resource. There is a LACK of hospitals that want to pay the premium for the product.

Ya sure, staff the shop with FM/IM. Most people will have equivalent outcomes. There will be some percentage that are overworked up, and exposed to radiation / drugs that they don't need. There will be a smaller percentage that are truly harmed. Just cause this number is small, does that mean it's ok? Are you ok with this "small" number even if it's you or someone you care about that's harmed?

It's like.....I wanna fly somewhere....I'd really like to fly on Emirites. It costs a lot. Alternatively I can fly there on Spirit. It's way cheaper and it'll probably get me there fine, but won't be as great a time, and probably won't be as safe.

I'm sorry there is just no way that's true.

Do you know any unemployed EPs?

How many job openings in EM are there right now?

I would bet even if you do know anyone in the former category, that the number in the latter category exceeds that by at least a factor of 20.

 

[Airborne Flt Doc]

Great post.

But, there needs to be a clear degree of autonomy between who can and should practice EM and who can't and shouldn't.

I have worked with IM and FM folks in the ER. Only ONE of them in 7 years has been "passable", and even then; they do things they shouldn't do that had a negative impact upon our department. The others? I was all-too-often asked: "Can I run this by you?" - "Can you look at this EKG?" - or (my favorite) "Can you place a central line for me?"

The EM residency expansion threads.... I think the animus behind the disdain is that the "new" residencies aren't academic, but are rather HCA sweatshops that are just looking to flood the market with low-quality grads who are indoctrinated into their grindhouse model of EM practice. I don't think there would be such outcry if say... [University of Piedmont State] went from 10 spots to 12. Its not the numbers; its the bosses.

I recommend not going to a ER site as FP/IM that does not have FP/IM leadership as you may have unprofessionalism & poor collegial environment if some of these individuals are representative of an ER Dept

Fortunately, there are many ER Directors and Assistant Directors that are FP/IM.

I have helped ER docs do procedures for a variety of reasons as an IM doc. Skill is up to the individual to commit to excellence.

 

[VA Hopeful Dr]

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

Many of your FP/IM colleagues have a lot of experience working Trauma/Ortho/OB managing and consulting these patients in the ICU/CCU/SICU.

Many military docs are FP/IM with more trauma & Peds experience than any expect

Yeah that's not even slightly true.

Why don't you find a list of hospitals that accept their board certification as opposed to ABMS and let us know how that goes.

 

[GonnaBeADoc2222]

I'm sorry there is just no way that's true.

Do you know any unemployed EPs?

How many job openings in EM are there right now?

I would bet even if you do know anyone in the former category, that the number in the latter category exceeds that by at least a factor of 20.

Agreed. But I don't think it's resource scarcity so much as a lack of willingness to pay. I haven't seen any locums rates for >$300/hr in awhile. What I see is ads for "come to BFE for 200 / hr". Theres are TONS of ABEM certified docs in the cities. You need to entice them.

 

[hoot504]

Airborne, you ignored my question. Just curious what your background is so that I can better gauge where these ridiculous posts are coming from?

 

[Airborne Flt Doc]

Yeah that's not even slightly true.

Why don't you find a list of hospitals that accept their board certification as opposed to ABMS and let us know how that goes.

You can get these from the recruiters sending the multitude of job opportunities.

 

[VA Hopeful Dr]

Agreed. But I don't think it's resource scarcity so much as a lack of willingness to pay. I haven't seen any locums rates for >$300/hr in awhile. What I see is ads for "come to BFE for 200 / hr". Theres are TONS of ABEM certified docs in the cities. You need to entice them.

But when you take them out of the city, then there's a job opening in the city. I promise you there are significantly more total jobs in emergency departments in this country than there are residency trained emergency physicians to fill them.

We have the exact same problem in family medicine.

 

[VA Hopeful Dr]

You can get these from the recruiters sending the multitude of job opportunities.

That's what I thought. Very few respectable hospitals will accept ABPS.

I know that I have worked for four different hospitals, five if you include residency, and they all required ABMS.