Combined EM/FP Residency

[tele turnin]

---

Members don't see this ad.

So I see a lot of talk/discussion about FP docs working in the ER and realize that as EM as a field produces more grads (and coupled with increased time as a specialty) it seems that in the future this will mainly occur at smaller community settings. I like the idea of practicing ER and mixing it with some outpatient FP. I want to know what kind of jobs graduates of these dual EM/FP programs end up getting.

It seems that in order to have everything covered, ie benefits for you and your family and malpractice, you would either have to pay it yourself or find a hospital that employees the ER docs and also run a FP clinic for them as you probably wouldn't be able to get those if you were working both specialties part time for different groups, employers, or yourself.

I think I would enjoy working 6ish 12 hr ER shifts a month then doing clinic 3-4 times weekly depending how busy it was. So far with my outpatient rotations they have all worked 5 days a week but could have honestly seen all of those patients in 3 days or less. That why I would lean toward 3 clinic days a week and alternate between 1-2 ER shifts weekly. Anybody know how realistic this is?

I know that there are a limited number of these programs (2 ACGME and 4 AOA ones) and I hope to be competitive. I am going to a new DO school, top quartile of my class, USMLE 1-238, and COMLEX 1-629. Other than that I'm not involved with much as I would rather spend my free time with family, skiing, mountain biking, etc.

If anybody has any clue on what kind of jobs are out there that would merit a dual residency or can refer me where to look it would be much appreciated. Thanks.

 

[dotcb]

EM pays more for less work (higher acuity, more procedures). It's also more flexible (shifts w/ no call, less paperwork). I think most would end up doing more or exclusively EM. They are really quite different fields. Most people who try to do 2 disciplines usually end up doing mostly one of them. I don't know anyone who does EM and fam med. I do know some who do family med and some urgent care. Most emergency physicians hate doing urgent care because of the low acuity (URI, sprain, back pain, 1 cm lac, etc.)

 

[Arcan57]

So I see a lot of talk/discussion about FP docs working in the ER and realize that as EM as a field produces more grads (and coupled with increased time as a specialty) it seems that in the future this will mainly occur at smaller community settings. I like the idea of practicing ER and mixing it with some outpatient FP. I want to know what kind of jobs graduates of these dual EM/FP programs end up getting.

It seems that in order to have everything covered, ie benefits for you and your family and malpractice, you would either have to pay it yourself or find a hospital that employees the ER docs and also run a FP clinic for them as you probably wouldn't be able to get those if you were working both specialties part time for different groups, employers, or yourself.

I think I would enjoy working 6ish 12 hr ER shifts a month then doing clinic 3-4 times weekly depending how busy it was. So far with my outpatient rotations they have all worked 5 days a week but could have honestly seen all of those patients in 3 days or less. That why I would lean toward 3 clinic days a week and alternate between 1-2 ER shifts weekly. Anybody know how realistic this is?

I know that there are a limited number of these programs (2 ACGME and 4 AOA ones) and I hope to be competitive. I am going to a new DO school, top quartile of my class, USMLE 1-238, and COMLEX 1-629. Other than that I'm not involved with much as I would rather spend my free time with family, skiing, mountain biking, etc.

If anybody has any clue on what kind of jobs are out there that would merit a dual residency or can refer me where to look it would be much appreciated. Thanks.

Part of the issue is going to be how easy will it be to build up your patient base working only 3 clinic days a week. If there is more than half the week your patients can't reach you and you are their primary care doctor, you had better be something pretty special. It's not so much a matter of you being able to see 5 days worth of patients in 3 days, it's those extra 2 days when your patients can't see you that will put you at a competitive disadvantage. There are definitely slots where docs will work part time for an existing group but these tend to be swing, evening, or weekend hours since nobody really complains about having to work during daylight weekday hours. I have seen a number of successful 4.5 days/wk practices, but that seems like fitting in 6 12h shifts would make for a pretty brutal lifestyle especially given the ending to your penultimate paragraph.

 

[coralis]

it is my humble opinion that the EM/FM combined program is not geared towards an urban practice but more for the rural and underserved population. Thus if you and another doc can cover clinic and the ED all week round sounds much better than no doc. Even just one EM/FM in the area with 3 clinic days sounds better to some places that have to travel for 2 hrs to wait another 4 to see an MD. Certainly much better than the potential 1 day/week traveling clinic.

 

[tele turnin]

I fully realize that I need to continue looking into how this would really work, and if it is even worth it. I mentioned some of my outpatient rotations where I feel they could do it in 3 days versus 5. To clarify these are clinics seeing 10 patients a day usually and never more than 15 making for soke very slow days. I've looked at job openings (I know it is far away but it was just to educate myself) and have seen openings for FP docs in areas I know/enjoy where they are looking for FP docs and mention increased income potential by covering ER shifts. I guess I would like to find something like that bit during contract negotions see if instead of the 2ish shifts per month they mention, try to bump that up and see if clinic hours could be reduced accordingly to keep the clinic busy on the days I am there. Most of these are at much smaller hospitals (level 3 to not having a rating). Thanks for the responses thus far, I've obviously got time to think about this and my mind could easily change.

 

[Apollyon]

your penultimate paragraph.

Major props for this. I got nothing else for the thread, but "preantepenultimate" - "fourth from the end".

 

[rosiemarie]

I ended up not going down this road (applying in a completely different field), but I at one point was considering both FM and EM and thought about the combined programs a lot. I know that for me, the appeal would not have been to practice them at the same time (unless I ended up in a rural setting such as coralis described), but rather to have a fallback plan burning out after 5-10 years of working shifts in the ER. My thought was that I would work ER for a few years, especially when the flexibility of shift work would be useful in having a family, etc, and then transition to primary care after my loans were paid off and I was old enough to want a more predictable schedule, etc etc. No idea if my logic had any merit!! (Clearly, I realized I didn't love either field enough to practice in it!) 🙄