Can Pediatric ER Docs work as Pediatricians?

[NYYk9005]

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This is a really stupid question, but I'm stupid:

If I were to get a residency in ER, then complete a 2 year fellowship in pediatric ER, would I ever be able to be a pediatrician or open my own pediatric clinic or something like that? My wife is planning on having a private practice in peds and I was wondering if I could join her when I'm like 55.

 

[Perrotfish]

This is a really stupid question, but I'm stupid:

If I were to get a residency in ER, then complete a 2 year fellowship in pediatric ER, would I ever be able to be a pediatrician or open my own pediatric clinic or something like that? My wife is planning on having a private practice in peds and I was wondering if I could join her when I'm like 55.

Technically yes. Anyone with a medical license can legally do anything in medicine in most states: residency/board certification have no legal standing except in a few parts of the country. You could finish Internship and open a practice as a neurosurgeon and that's legal in most of the country.

Practically the issues would be finding someone to hire you and finding someone to insure you. The reason that you can't really work as a neurosurgeon with just an Internship is that you could never get hospital privileges, malpractice insurance, reimbursement from some insurance companies, or a job. Owning your own practice solves only a handful of those issues unless you set up an all cash business, which while a great strategy for cosmetic derm and hair transplants doesn't really work for pediatrics. I don't really known how selective insurance is about board certification, though. Also there is an ethical side of this: acute visits are less than half of a normal Pediatric outpatient practice, and you're missing the training that teaches all the screening. Are you confident you won't miss anything based on just a Peds EM fellowship? Its not rocket science or anything, but as a Peds Intern I missed my fair share of developmental and physical screenings and it does take practice to get to a negligible miss rate. A missed autism diagnosis at a 2 year screening, for example, is devastating. The intensive therapy that improves their verbal IQ by standard deviations doesn't really work very well when you start it later in life (like age 3-5).

If you're 100% sure you want to do Peds EM with some Peds, why do an EM residency at all? Pediatrics has a three year Peds EM fellowship that you can do after residency that gets you to the same place and you'll only have to deal with one one hundredth as many belligerent drug addicts.

 

[deleted547339]

2nd what perrotfish said except:

1- you're wife could be the PMD and you could so walk in sick visits a couple days a week

2 - there are just as many belligerent drug addicts in the Peds ED, we just call them parents.

 

[NYYk9005]

Thanks for the interesting replies.

I couldn't imagine that being common though. Why don't more ER docs simply join a private group as the walk in clinic go to guy?

Would malpractice insurance companies really scorn EM docs who work in PC or peds (if they are a pediatric EM doc) if the insurance companies know they only handle walk ins?

Have you ever heard of EM docs doing this, and if it is overly challenging?

 

[Perrotfish]

Thanks for the interesting replies.

I couldn't imagine that being common though. Why don't more ER docs simply join a private group as the walk in clinic go to guy?

Would malpractice insurance companies really scorn EM docs who work in PC or peds (if they are a pediatric EM doc) if the insurance companies know they only handle walk ins?

Have you ever heard of EM docs doing this, and if it is overly challenging?

I have certainly heard of EM physicians working in urgent care centers, which is basically an outpatient clinic without checkups for chronic conditions. Its not that common, if only because an EM doctor who wants to pick up an additional 12 hours of work is likely to make 2-3 times as much picking up an ED shift as an urgent care shift. I haven't seen an EM/Peds EM doctor working in a pediatric urgent care center specifically, where the pay differential would be even greater, but I would guess it could be done. I still think Peds --> Peds EM would be the better training pathway for that goal, though.

 

[witzelsucht]

This is a pretty easy problem to solve. As other people said: peds -> peds EM fellowship. If there's even an inkling that you might want to do general peds, go the route that will give you the most training and most options.

 

[deleted547339]

This is a pretty easy problem to solve. As other people said: peds -> peds EM fellowship. If there's even an inkling that you might want to do general peds, go the route that will give you the most training and most options.

And, very few people do peds-em from EM. It's just so different from EM. I like EM because the variety of pathology, critically ill patients, complex medical problems and procedures. Peds EM, for the most part, has healthy patients with a lot of repetition.

Our Peds EM fellowship has 100% peds trained fellows. And I don't know anyone in my program who wants to go into peds.

If you could see yourself being happy in peds, do peds. If you could see yourself happy in EM, do EM. Like with all residencies, don't do a residency if you wouldn't be happy doing that for the rest of your life.

 

[NYYk9005]

Thank you all for your responses so far. The thing about my situation is that my main desire is to go into emergency medicine for adults. The pediatric portion I do care about and have some interest in but it does not outweigh the interest I have been dealing with adults with acute conditions.

I am just thinking about the options I have when I get older to protect against burnout, or very difficult scheduling for an old man.

 

[e30ftw]

I couldn't imagine that being common though. Why don't more ER docs simply join a private group as the walk in clinic go to guy?

Because being available for "walk in clinic" patients at a primary care office doesn't pay $200/hr. Also you aren't going to be using any of the skills you use in an EM residency to do this job.

Would malpractice insurance companies really scorn EM docs who work in PC or peds (if they are a pediatric EM doc) if the insurance companies know they only handle walk ins?

Have you ever heard of EM docs doing this, and if it is overly challenging?

EM residency does not prepare you for primary care. You could probably find a malpractice carrier to cover you, but would it be worth it? An acute problem in a PCP office is anyone with chest pain and anyone with an o2 sat <90%. These are mostly stable, easy bread and butter patients in an ED.

It does not sound challenging, it sounds boring. If you don't have the resources of an emergency department, the only way you can get "true" emergencies the care they need is by referring them to the local ED. So why bother?

jmo.

 

[NYYk9005]

The reason I'm asking is because while I love the thought of emergency medicine and all that goes with it, I've been warned against burnouts and night shifts when I get older. I am just thinking about what options ER docs have when they do in fact get older but still want to practice medicine, albeit for less money and in less acute situations.

I guess the more simple answer is to just join or open an urgent care/walk in/doc in a box like clinic to have somewhat controllable schedules and not deal with the stress of dire emergencies if I ever feel overwhelmed or burned out.

On a related note, why don't ppl cite urgent care clinics as a protection from burnout when ED docs aren't young and energetic anymore? Or am I just not in the loop for it? Is it just bc the compensation is much less?

 

[Perrotfish]

The reason I'm asking is because while I love the thought of emergency medicine and all that goes with it, I've been warned against burnouts and night shifts when I get older. I am just thinking about what options ER docs have when they do in fact get older but still want to practice medicine, albeit for less money and in less acute situations.

I guess the more simple answer is to just join or open an urgent care/walk in/doc in a box like clinic to have somewhat controllable schedules and not deal with the stress of dire emergencies if I ever feel overwhelmed or burned out.

On a related note, why don't ppl cite urgent care clinics as a protection from burnout when ED docs aren't young and energetic anymore? Or am I just not in the loop for it? Is it just bc the compensation is much less?

I think you might be underestimating the stress of clinic jobs.The patients are healthier but the volume is brutal, and in each haystack there is a legitimately sick needle you're not allowed to miss. A 4-5 PPH, 5 day/week, 9 hr/day pediatric clinic is not drastically more forgiving than a 2.5 PPH 3 day/week 12 hr/shift ER job, even taking the variable schedule of an ER job into account. Some urban urgent cares are even worse than that, I have seen urgent care clinics that scheduled more than 6 patients per hour. That includes your time to document. I knew one FP that was doing a patient every 7 minutes. At that point you're just guessing their diagnosis based on their chief complaint.

If you're worried about burnout, have you thought about just avoiding lifestyle inflation so that you can work less as you get older? You can negotiate your hours with your group, and at an older age you can probably arrange a more forgiving schedule (lighter, all days, etc) in exchange for less money. For that matter, if you want to get away from the stress of the ED entirely, you'd be more free to help out at a more reasonable pace in an urgent care or in your wife's Peds practice: 3.5 PPH at a very modest $50/hr might actually be a kind of semi-retirement job, while 6 PPH at $120/hr sounds worse than the ED. Save aggressively, live modestly, and don't get divorced. With a doctor wife if you avoid lifestyle inflation you should be able to cut your hours when you're 55 without ruining your retirement.

 

[snoopy85k]

There are a handful of 5 year EM/Peds programs in Indiana, Arizona, Maryland and Louisiana. You are double boarded in Peds and EM. You can work in a Peds ED, "regular ED," open a peds clinic, do fellowship to get further specialization on either side (tox, critical care, peds cards, peds GI, etc). Might be worth considering if you are looking at 5 years with fellowship anyway.

 

[Perrotfish]

There are a handful of 5 year EM/Peds programs in Indiana, Arizona, Maryland and Louisiana. You are double boarded in Peds and EM. You can work in a Peds ED, "regular ED," open a peds clinic, do fellowship to get further specialization on either side (tox, critical care, peds cards, peds GI, etc). Might be worth considering if you are looking at 5 years with fellowship anyway.

The only thing to be aware of is that being double boarded in Peds and EM does not mean you are boarded in Peds EM. If your goal is the ED at a top children's hospital, and their policy is that a Peds EM doctor needs to manage each section of the ED, I'm not sure they'd view that combination of certifications as equivalent to a real Peds EM fellowship. I'm better some would and some would not.

 

[deuist]

The reason I'm asking is because while I love the thought of emergency medicine and all that goes with it, I've been warned against burnouts and night shifts when I get older. I am just thinking about what options ER docs have when they do in fact get older but still want to practice medicine, albeit for less money and in less acute situations.

You could move into administration. You'd go to hospital meetings and create work schedules. In return you would have fewer shifts. One person mentioned pediatrics/EM as a combined residency. It's five years long and gives you more options after graduating than a peds EM fellowship does. Not all peds ED's require the fellowship to work there. If you're interested, the four programs with this combined program are University of Arizona, Indiana University, Louisiana State University, and University of Maryland

 

[NOsaintsfan]

The reason I'm asking is because while I love the thought of emergency medicine and all that goes with it, I've been warned against burnouts and night shifts when I get older. I am just thinking about what options ER docs have when they do in fact get older but still want to practice medicine, albeit for less money and in less acute situations.

I guess the more simple answer is to just join or open an urgent care/walk in/doc in a box like clinic to have somewhat controllable schedules and not deal with the stress of dire emergencies if I ever feel overwhelmed or burned out.

On a related note, why don't ppl cite urgent care clinics as a protection from burnout when ED docs aren't young and energetic anymore? Or am I just not in the loop for it? Is it just bc the compensation is much less?

Based on your stated goals you should consider a combined EM/FM residency. The FM part will give you exposure to kids and train you for outpatient clinic. No you won't be a pediatrician but you'll have the training to justify seeing kids in an outpatient setting. Just something to think about.

 

[Dr.Evil1]

You should do an emergency medicine residency and worry about working in a Peds clinic when you're actually 55 a lot can change in (I would assume) 30 years. To do two or three years of training for something you may want to do in 30 years seems ridiculous.