Compensation of an FP in an ED

[DoctahB]

Hi All,

MS4 Strongly considering EM & FM. Not that compensation should be a deciding factor, but wondering if anyone has any insight as to the compensation of a Family Med Practitioner working in an ED as compared to an EM-train (yes, I know it depends on location).

Additionally, can an FP join a locum tenens group for EM?

Tried to find the answer to this online but no dice. This same thread will be posted in the FM section for their views too. Thanks!

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[RoyBasch]

Hi All,

MS4 Strongly considering EM & FM. Not that compensation should be a deciding factor, but wondering if anyone has any insight as to the compensation of a Family Med Practitioner working in an ED as compared to an EM-train (yes, I know it depends on location).

Additionally, can an FP join a locum tenens group for EM?

Tried to find the answer to this online but no dice. This same thread will be posted in the FM section for their views too. Thanks!

Generally the pay will be the same, the issue will be finding hospitals that will give you privileges to work in the ER at all without being board eligible for EM (having completed an ACGME accredited residency in EM) or board certified in EM.

The ERs that still have non-EM trained people in them tend to be rural locations that are struggling to get enough ER physicians to keep the ER staffed. It is hard to find ERs in medium to large cities that would hier a non board eligible/certified physician.

Yes, there are some non-EM trained older practitioners working in a major metro ERs, but they have usually been doing it a long time and have been grandfathered in at this point by their literally decades of experience in the ER.

I would say if you want to work in an ER, do an ER residency. If you do FP but want to work in an ER you will be severely limiting your options of WHERE you can practice--most likely smaller towns and rural areas. Conversely if you want to BE an FP, do an FP residency. ER residency does not train you how to provide continuity of care and health maintenance (all jokes aside about frequent flyers and such).

 

[Angry Birds]

Generally the pay will be the same,

I used to think this, but I realized it's simply not true. Your bargaining power is way higher as an ABEM physician, and you can thus negotiate a far higher salary than your FP colleague working in the same ER. I have first-hand experience with this.

MS4 Strongly considering EM & FM. Not that compensation should be a deciding factor,

You must be smoking crack if you think compensation should not just be a factor in your decision but a major factor, especially if the choice is between FP and EM with a hope to work in an ER. The money in ER is way, way higher.

 

[miacomet]

I used to think this, but I realized it's simply not true. Your bargaining power is way higher as an ABEM physician, and you can thus negotiate a far higher salary than your FP colleague working in the same ER. I have first-hand experience with this.



You must be smoking crack if you think compensation should not just be a factor in your decision but a major factor, especially if the choice is between FP and EM with a hope to work in an ER. The money in ER is way, way higher.

Agreed. We used to have FPs in our ED, and they earned 30% less.

 

[Angry Birds]

Agreed. We used to have FPs in our ED, and they earned 30% less.

For me, I got paid almost double the FP.

 

[GonnaBeADoc2222]

If you want to work in the ED, you should get the proper training, meaning do an EM residency.

I continue to be somewhat offended by these threads that are like "Hey I'm non EM specialty X, I can moonlight in the ED right?!"

You simply do not have the training in resuscitation, procedures, managing department flow. Even more importantly, you lack training in the core mindset of an EP. Without this, you are a danger to patients in the department.

Get the training for the job you want.

Also, compensation should definitely matter.

 

[Apollyon]

This same thread will be posted in the FM section for their views too. Thanks!

It's likely one of the threads will be closed, because cross-posting is a TOS violation.

 

[VA Hopeful Dr]

I used to think this, but I realized it's simply not true. Your bargaining power is way higher as an ABEM physician, and you can thus negotiate a far higher salary than your FP colleague working in the same ER. I have first-hand experience with this.



You must be smoking crack if you think compensation should not just be a factor in your decision but a major factor, especially if the choice is between FP and EM with a hope to work in an ER. The money in ER is way, way higher.

Bingo. If you know you want to work in an ED full time, then do an EM residency.

 

[deleted859535]

Hi All,

MS4 Strongly considering EM & FM. Not that compensation should be a deciding factor, but wondering if anyone has any insight as to the compensation of a Family Med Practitioner working in an ED as compared to an EM-train (yes, I know it depends on location).

Additionally, can an FP join a locum tenens group for EM?

Tried to find the answer to this online but no dice. This same thread will be posted in the FM section for their views too. Thanks!

I would say if you want to work in an ER, do an ER residency. If you do FP but want to work in an ER you will be severely limiting your options of WHERE you can practice--most likely smaller towns and rural areas. Conversely if you want to BE an FP, do an FP residency. ER residency does not train you how to provide continuity of care and health maintenance (all jokes aside about frequent flyers and such).

This.

OP: I'm a boarded emergency physician. I know I can't be a good PCP. The good PCPs should know they can't be me. Similarly, I read my own imaging. I also know I'm not a radiologist and that when I'm in doubt, I defer to their interpretation.

Figure out if you want to be an EP or not, because if you do, choosing to do anything but an EM residency is shooting yourself in the foot.

 

[emergentmd]

Newly minted FP who wants to moonlight in the ED is dangerous. I know many FP docs who have done EM for years and are really good EM docs.

But the new FP docs who I have seen in the ED is just plain dangerous and poorly equipped. There are subtleties with EM medicine that FP docs new saw in their training.

You can't CT everyone's chest with CP and call yourself an EM doc. You have to have all of the dangerous differentials in your mind but be able to distinguish b/t someone who is histrionic and who may have a PE.

 

[It's lupus!]

Arguably, if the OP wanted to take the long route couldn't he do FM and then follow on with an EM fellowship? It would be round about, not very cost effective, and a tad frustrating if the ultimate goal is EM, but isn't this a doable course?

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[BoardingDoc]

Arguably, if the OP wanted to take the long route couldn't he do FM and then follow on with an EM fellowship? It would be round about, not very cost effective, and a tad frustrating if the ultimate goal is EM, but isn't this a doable course?

Sent from my Pixel XL using SDN mobile

EM fellowship != EM trained. I don't know a single shop in my city or surrounding area which would hire an FM doc to work in the ED, regardless of what fellowships they had done. I really only see that fellowship as useful for someone who is dead set on working in an ED, couldn't get into an EM residency, is willing to work in the boonies and wants additional training (good idea) before jumping in.

 

[GonnaBeADoc2222]

Jeez. Don't understand why we continue to get this disrespect. Pretty simple: if you want to work in the ED, do an EM residency get board certified. I don't care what fake news merit badge 12 month "fellowship" you did after FP residency. You are not qualified. You haven't assessed the volume of patients you need to have assessed in an ED setting during training to be competent. You don't have the airway and vascular access numbers. I wouldn't begin to think I was qualified to do any other field than EM with a little "fellowship" tacked onto my residency training. Why is it so difficult for people to recognize the reciprocal?

 

[It's lupus!]

Jeez. Don't understand why we continue to get this disrespect. Pretty simple: if you want to work in the ED, do an EM residency get board certified. I don't care what fake news merit badge 12 month "fellowship" you did after FP residency. You are not qualified. You haven't assessed the volume of patients you need to have assessed in an ED setting during training to be competent. You don't have the airway and vascular access numbers. I wouldn't begin to think I was qualified to do any other field than EM with a little "fellowship" tacked onto my residency training. Why is it so difficult for people to recognize the reciprocal?

It's not disrespect. My post comes from ignorance. There's a question mark behind it for a reason. You are talking to students. Calm down. It may seem intuitively obvious to you but for others it may not be.

"You could do EM fellowship through FP but you're available work locations may be limited and possibly undesirable. Your training will be subpar compared to a traditional EM residency which is concerning for me in this specialty and also informs your struggles with job placement mentioned earlier."

So much simplier. So much less condescension...

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[Rendar5]

You could do FM/EM or IM/EM combined residency

 

[gro2001]

It's not disrespect. My post comes from ignorance. There's a question mark behind it for a reason. You are talking to students. Calm down. It may seem intuitively obvious to you but for others it may not be.

"You could do EM fellowship through FP but you're available work locations may be limited and possibly undesirable. Your training will be subpar compared to a traditional EM residency which is concerning for me in this specialty and also informs your struggles with job placement mentioned earlier."

So much simplier. So much less condescension...

Sent from my Pixel XL using SDN mobile

The reason that you were snapped at is that this is a very common thing we hear on this board. So much so that it is linked in the FAQ, with the oldest thread there discussing this issue going back to 2007. In my 12 years on SDN I see this come up at least monthly. I say this not to imply that you should have read the FAQ before posting or to discourage you from asking questions, but rather to give you some perspective of how many times everyone here has responded to basically the same question. And while you, personally, are surely not coming from a place of malice, the reason that students like yourself continue to have the impression that there is some non-inferior alternative to EM residency for EM work is that your seniors in other specialties gave you that impression. And that does come with a dose of disrespect.

 

[MedicineZ0Z]

If you want to work in the ED, you should get the proper training, meaning do an EM residency.

I continue to be somewhat offended by these threads that are like "Hey I'm non EM specialty X, I can moonlight in the ED right?!"

You simply do not have the training in resuscitation, procedures, managing department flow. Even more importantly, you lack training in the core mindset of an EP. Without this, you are a danger to patients in the department.

Get the training for the job you want.

Also, compensation should definitely matter.

Unless you're a PA/NP, in which case you're good to go

 

[deleted859535]

Unless you're a PA/NP, in which case you're good to go

Cute, but apples and oranges. FM in a busy / high-acuity ED where EM training is most utilized may as well be a "good PA" in many respects. Better than PAs in some ways but still not the same as an EP.

That's not to mention the times I caught subtle but significant misses from our PAs who, while great overall, are not specialty-trained emergency physicians.

 

[MedicineZ0Z]

Cute, but apples and oranges. FM in a busy / high-acuity ED where EM training is most utilized may as well be a "good PA" in many respects. Better than PAs in some ways but still not the same as an EP.

That's not to mention the times I caught subtle but significant misses from our PAs who, while great overall, are not specialty-trained emergency physicians.

You missed the point.
Seeing the outrage at an FP being in an ED, who is infinitely more skilled/knowledgeable than a midlevel - but no outrage at a PA/NP? The "supervision" is also a joke in the vast majority of cases.
Clearly you carry some bias against FPs to even compare them to a PA. Reality is many of these FPs have done months of ED and some anesthesia during all of their elective time and hence have suitable skills for the vast majority of what comes in through the door.

It's better to fix the real outrage, and that is midlevels in a high acuity setting rather than focus on fighting other doctors

 

[deleted859535]

You missed the point.
Seeing the outrage at an FP being in an ED, who is infinitely more skilled/knowledgeable than a midlevel - but no outrage at a PA/NP? The "supervision" is also a joke in the vast majority of cases.
Clearly you carry some bias against FPs to even compare them to a PA. Reality is many of these FPs have done months of ED and some anesthesia during all of their elective time and hence have suitable skills for the vast majority of what comes in through the door.

It's better to fix the real outrage, and that is midlevels in a high acuity setting rather than focus on fighting other doctors

Didn't miss the point. I also am an EP and know the specialty better than you.

 

[MedicineZ0Z]

Didn't miss the point. I also am an EP and know the specialty better than you.

Knowing a specialty better has nothing to do with supporting midlevels and fighting other physicians. Otherwise the same specialty wouldn't have members strongly in favor and strongly opposed to PAs/NPs.

 

[Rendar5]

If you preach that from the perspective of an emergency physician, you'll be able to convince more people. But most attending physicians don't change their minds or practice based on what medical students suggest, the same as most medical students wouldn't change their study habits or focus or CV based on what high school or college students suggest.

 

[Shufflin]

Not EM or FM here. A bit surprised at the hypothesis, that one would even consider that it's even possible to handle EM work trained in a different specialty, especially FM. Say I'm in the Army, trained to drive tanks. You think I'm suitable to be on the front lines as a Marine?

I can run a Psych ED, that's difficult enough.

EM docs deserve lots of respect for the barrage of insanity they must face and handle it with great skill, speed, and smiles (damn patient satisfaction surveys).

 

[VA Hopeful Dr]

The reason that you were snapped at is that this is a very common thing we hear on this board. So much so that it is linked in the FAQ, with the oldest thread there discussing this issue going back to 2007. In my 12 years on SDN I see this come up at least monthly. I say this not to imply that you should have read the FAQ before posting or to discourage you from asking questions, but rather to give you some perspective of how many times everyone here has responded to basically the same question. And while you, personally, are surely not coming from a place of malice, the reason that students like yourself continue to have the impression that there is some non-inferior alternative to EM residency for EM work is that your seniors in other specialties gave you that impression. And that does come with a dose of disrespect.

Not necessarily. If the FP is old enough, he might predate EM (or very close to it).

There are also still quite a few FPs in rural ERs.

 

[gro2001]

Not necessarily. If the FP is old enough, he might predate EM (or very close to it).

There are also still quite a few FPs in rural ERs.

Yes, that's true. I've worked with plenty of grandfathered EPs. Many of those folks helped shape our specialty. They'd be the first to tell you that there is no acceptable substitute to doing an EM residency in 2018.

I don't think so many medical students are coming away with the impression that FM training is perfectly suitable for ED work because they've met lots of grandfathered EPs or badass country FPs. I think it's because they encounter non EM trained medical school faculty members who have not themselves worked in the ER (at least in the last couple of decades) who speak negatively of the specialty and paint a false equivalence.

 

[Lexdiamondz]

You missed the point.
Seeing the outrage at an FP being in an ED, who is infinitely more skilled/knowledgeable than a midlevel - but no outrage at a PA/NP? The "supervision" is also a joke in the vast majority of cases.
Clearly you carry some bias against FPs to even compare them to a PA. Reality is many of these FPs have done months of ED and some anesthesia during all of their elective time and hence have suitable skills for the vast majority of what comes in through the door.

It's better to fix the real outrage, and that is midlevels in a high acuity setting rather than focus on fighting other doctors

Midlevels have been in the ED for some time and nobody is trying that hard to have midlevels see and manage ESI 1-2 cases solo in any ED I've seen. To be honest, I'd trust a PA who worked in an ED for three years much more than I'd trust a FP who did a 3 year FM residency.

The specialty of Emergency Medicine has had it's own licensing board for 30 years. The idea that someone could simply do my job without training for my job is pretty damn outrageous. You doing "months of elective time" is not equivalent in any way to an EM residency. You doing an anaesthesia elective for a couple weeks where you only tubed cherry-picked stable patients who are NPO is not analogous to doing a crash intubation in a guy in a c-collar with his OP filled with blood and broken teeth.

 

[GonnaBeADoc2222]

Yes, that's true. I've worked with plenty of grandfathered EPs. Many of those folks helped shape our specialty. They'd be the first to tell you that there is no acceptable substitute to doing an EM residency in 2018.

I don't think so many medical students are coming away with the impression that FM training is perfectly suitable for ED work because they've met lots of grandfathered EPs or badass country FPs. I think it's because they encounter non EM trained medical school faculty members who have not themselves worked in the ER (at least in the last couple of decades) who speak negatively of the specialty and paint a false equivalence.

It's cool, I get it. We make more money, work less hours, "give" them work to do, ask them questions. It's usually after they come down and do their off service PGY3 resident rotation in the ED and the EM PGY2 is running circles around them managing 3x the volume of sicker patients that the smart ones actually realize what we do. As an aside, I really like working with most of my consultants. Some of my favorite times in the ED are when they come down to the department and we can have a face to face discussion about a case and how to best manage it together.

 

[MedicineZ0Z]

Midlevels have been in the ED for some time and nobody is trying that hard to have midlevels see and manage ESI 1-2 cases solo in any ED I've seen. To be honest, I'd trust a PA who worked in an ED for three years much more than I'd trust a FP who did a 3 year FM residency.

The specialty of Emergency Medicine has had it's own licensing board for 30 years. The idea that someone could simply do my job without training for my job is pretty damn outrageous. You doing "months of elective time" is not equivalent in any way to an EM residency. You doing an anaesthesia elective for a couple weeks where you only tubed cherry-picked stable patients who are NPO is not analogous to doing a crash intubation in a guy in a c-collar with his OP filled with blood and broken teeth.

I've heard the exact opposite. Also given my personal exps, wouldn't want a midlevel near me as a patient in the ED.

As for tubing, there are glidescopes/bougies + you make it seem like ER docs are pros at intubating when in 2018 that's dragging further from the truth.

 

[GonnaBeADoc2222]

I've heard the exact opposite. Also given my personal exps, wouldn't want a midlevel near me as a patient in the ED.

As for tubing, there are glidescopes/bougies + you make it seem like ER docs are pros at intubating when in 2018 that's dragging further from the truth.

Wrong. So wrong.

100% want my experienced ED PA to reduce my distal radius fracture rather than any fresh FP grad (notwithstanding the ones with 10+ years experience as mentioned above).

Your comments on airway sorely betray your inexperience. Video laryngoscopy and bougies don't make airway management "easy." And yes, we are pros at intubating. I've had to take over from anesthesia attendings on more than one occasion.

Mods, can we close this goat rodeo of a thread? Tired of med studs telling attendings what it is.

 

[SpacemanSpifff]

I've heard the exact opposite. Also given my personal exps, wouldn't want a midlevel near me as a patient in the ED.

As for tubing, there are glidescopes/bougies + you make it seem like ER docs are pros at intubating when in 2018 that's dragging further from the truth.

VL and bougies are only useful in the hands of an experienced provider. VL can overcome some obstacles, but is not a panacea to the difficult airway, hence the disagreement between experienced providers on its general utility. A brief twitter search will give you an idea of how controversial your statement is.

Likewise, bougies are an incredible advantage in the hands of someone who has been trained to use them. Not so much in the context of an airway n00b.

Airway management is a core component of emergency medicine training. You can't really get that experience through a brief elective in an FM program. I echo @gro2001 -- FM trained EM physicians are becoming a thing of the past. Not because FM physicians are somehow lesser than EM, but because the training pathway is now commonly available, and you should train for your job.

 

[Lexdiamondz]

I've heard the exact opposite. Also given my personal exps, wouldn't want a midlevel near me as a patient in the ED.

As for tubing, there are glidescopes/bougies + you make it seem like ER docs are pros at intubating when in 2018 that's dragging further from the truth.

The fact that you're basing this on things you've heard rather than seen and experienced yourself makes your opinion, quite frankly, worthless.You don't seem to know much about EM (or FM for that matter) and your statements belie a woeful lack of actual clinical experience.

And yes, ER docs are pros at airway. We are the only specialty in medicine besides anaesthesia (and maybe ENT) that regularly manages emergent airways. It is a core competency of our specialty and much, much more difficult than you, an MS3, could probably comprehend at your level of clinical knowledge.

 

[Brigade4Radiant]

Most docs would trust a specialty PA like urology and ENT to do a portion of what they do then a doctor in a different specialty also PAs and doctors are not comparable.

 

[deleted109597]

Not necessarily. If the FP is old enough, he might predate EM (or very close to it).

Yes. But they still shouldn't repeat it. It would be like them saying "we only use dilantin for seizures" or whatever else medicine was doing when they started. It turns out things change, so should people.

There are also still quite a few FPs in rural ERs.

Basically the same as their GI/OB practice. Most urban areas prefer specialists. Most rural areas cannot recruit them so they allow more general practice. And I respect those generalists, friends with many here and in Oz. But they still aren't emergency docs, gastroenterologists, or obstetricians.

 

[VA Hopeful Dr]

Yes. But they still shouldn't repeat it. It would be like them saying "we only use dilantin for seizures" or whatever else medicine was doing when they started. It turns out things change, so should people.


Basically the same as their GI/OB practice. Most urban areas prefer specialists. Most rural areas cannot recruit them so they allow more general practice. And I respect those generalists, friends with many here and in Oz. But they still aren't emergency docs, gastroenterologists, or obstetricians.

Neither is a slight on EM which was literally my only point

 

[W19]

If you want to work in the ED, you should get the proper training, meaning do an EM residency.

I continue to be somewhat offended by these threads that are like "Hey I'm non EM specialty X, I can moonlight in the ED right?!"

You simply do not have the training in resuscitation, procedures, managing department flow. Even more importantly, you lack training in the core mindset of an EP. Without this, you are a danger to patients in the department.

Get the training for the job you want.

Also, compensation should definitely matter.

Not sure why you are offended since I see midlevels working in the ED... A lot stuffs that come to the ED are not truly emergency.

 

[Lexdiamondz]

Not sure why you are offended since I see midlevels working in the ED... A lot stuffs that come to the ED are not truly emergency.

That's not the point though. Even though 70% of what comes through the average ED is primary-care level stuff, the 25% who are actually sick and the 5% who are critically ill are who you're being paid to manage and managing those patients while maintaining an efficient workflow, performing procedures, working up/dispo-ing everyone requires a skillset outside of what a FM or IM residency will teach you.

If you're working in the ED as an attending, regardless of your training background you will be held to the same standards as a board-certified EM physician. If you don't have that training you'll have alot to explain in your deposition once you get sued for fxcking up.

 

[W19]

@Lexdiamondz I am not sure if it's something an ED doc should be offended about. A lot of rural ED are staffed by FM/IM docs. However, I understand your point that it is best to do a residency in EM if you want to make a living as an ED doc...

 

[deleted109597]

Neither is a slight on EM which was literally my only point

I know you aren't using it as one, but when we still have piles of medical students being told they can be EPs after FM residency, just like they did, it causes problems for the students and continues the mentality of the old docs that EPs aren't very good.
I'm still waiting for anyone to explain why hospitals don't allow non-boarded surgeons and non-boarded anesthesiologists, but for some reason they don't think emergencies require boards.

 

[sunshinefl]

I know you aren't using it as one, but when we still have piles of medical students being told they can be EPs after FM residency, just like they did, it causes problems for the students and continues the mentality of the old docs that EPs aren't very good.
I'm still waiting for anyone to explain why hospitals don't allow non-boarded surgeons and non-boarded anesthesiologists, but for some reason they don't think emergencies require boards.

I have total respect for each specialty having its expertise. I hear what you’re saying though. We had a “specialty selection night” where local residencies came and presented about their specialty. Family medicine’s turn involved hyping up all of their fellowship options and work opportunities, including emergency medicine.

 

[MedicineZ0Z]

I know you aren't using it as one, but when we still have piles of medical students being told they can be EPs after FM residency, just like they did, it causes problems for the students and continues the mentality of the old docs that EPs aren't very good.
I'm still waiting for anyone to explain why hospitals don't allow non-boarded surgeons and non-boarded anesthesiologists, but for some reason they don't think emergencies require boards.

No one has said they can be as good as an EP attending after an FM residency. More like... working in the ED with reasonable back up and/or fast track. It's also theoretical as to what % of ED complaints a FP can manage. A well trained FP can certainly manage more than just 70% like suggested above... but certainly not 100% like you seem to think med students have implied.


Again, the true outrage is why you're okay with a midlevel working in the ED (with "supervison") but not an FP? How about a PA with 6 months exp who has barely any true supervision (realistic scenario)? Compared with an FP who did a very intense residency with lots of elective time in the ED? Keep in mind the PA has like a month of "training" in the ED. If it's an NP, they probably have zero training. Yet you're fine with them?


Here's a nice thread outlining why your pro-midlevel anti-doctor stance is incredibly dangerous: Family Med + Emergency Medicine Fellowship

 

[deleted109597]

You seem to be putting lots of words in my mouth.
I went to medical school. One that had 3 different FM residencies, but no EM program. They all tried very hard to discourage OB/Gyn and EM residencies. They weren't implying it was to be the extra set of hands in an big ED. They were pushing it as full equivalence. Lots of other people do as well, that's why you keep finding them working at single coverage shops.
The PA is working under my license and I can tell them what to do. The FM doc isn't. I still have to deal with both of their screwups though. I'm not a fan of PA/NP in the emergency department either. I think that if you see one of them you should get an urgent care bill, because that's the care they provide. I don't run a CMG though so I don't make the rules.

 

[MedicineZ0Z]

You seem to be putting lots of words in my mouth.
I went to medical school. One that had 3 different FM residencies, but no EM program. They all tried very hard to discourage OB/Gyn and EM residencies. They weren't implying it was to be the extra set of hands in an big ED. They were pushing it as full equivalence. Lots of other people do as well, that's why you keep finding them working at single coverage shops.
The PA is working under my license and I can tell them what to do. The FM doc isn't. I still have to deal with both of their screwups though. I'm not a fan of PA/NP in the emergency department either. I think that if you see one of them you should get an urgent care bill, because that's the care they provide. I don't run a CMG though so I don't make the rules.

This isn't about how you do things though. Supervision of midlevels continues to be a complete joke nationwide. And now... we have PAs supervising doctors:

depends on the PA. typical new grad pa vs new grad fm doc, doc wins. someone who was a medic in a busy system for 10 years who became a pa and has spent the last 10+ years as an em pa seeing all levels of acuity and doing all procedures will run circles around a new family medicine physician in the ED. I precept pgy 1 to pgy-3 family medicine residents at 3 facilities and know this to be true.

Happy?

Point being that you're fighting the wrong battle. Fight the high priority one first, save the low priority one for after.

 

[Angry Birds]

As for tubing, there are glidescopes/bougies + you make it seem like ER docs are pros at intubating when in 2018 that's dragging further from the truth.

Dude, are you serious?? You deserve to get smacked for this ignorant comment.

-----

Anyways, I think it's silly that we've gotten into this debate about EM PA vs FP MD.

There is only one correct answer which is ABEM EP.

 

[deleted859535]

Dude, are you serious?? You deserve to get smacked for this ignorant comment.

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Anyways, I think it's silly that we've gotten into this debate about EM PA vs FP MD.

There is only one correct answer which is ABEM EP.

Very silly. Both that comment and the debate which is morphing into something it wasn't initially.

 

[GonnaBeADoc2222]

Like I said. Let's lock this dumpster fire. Children lecturing the adults. Should we cross post on the high school forum to get their take too?

 

[VA Hopeful Dr]

I know you aren't using it as one, but when we still have piles of medical students being told they can be EPs after FM residency, just like they did, it causes problems for the students and continues the mentality of the old docs that EPs aren't very good.
I'm still waiting for anyone to explain why hospitals don't allow non-boarded surgeons and non-boarded anesthesiologists, but for some reason they don't think emergencies require boards.

In some of those same rural hospitals, they do. There are still some (I would guess no more than a dozen, but that's just a guess) of FPs who do things like tonsils and c-sections.

That topic in fact comes up every so often in the FM forum with the answer of "if you go rural enough, you can usually find somewhere that will let you do it". Same thing we tell people wanting to do EM work from an FM residency. As soon as all the rural jobs are filled with EM-boarded docs, that'll go away. Its well on the way, as the number of EM locums jobs I'm seeing that will take FPs has dropped quite a bit in the 5 years I've been out of residency.

 

[VA Hopeful Dr]

You seem to be putting lots of words in my mouth.
I went to medical school. One that had 3 different FM residencies, but no EM program. They all tried very hard to discourage OB/Gyn and EM residencies. They weren't implying it was to be the extra set of hands in an big ED. They were pushing it as full equivalence. Lots of other people do as well, that's why you keep finding them working at single coverage shops.
The PA is working under my license and I can tell them what to do. The FM doc isn't. I still have to deal with both of their screwups though. I'm not a fan of PA/NP in the emergency department either. I think that if you see one of them you should get an urgent care bill, because that's the care they provide. I don't run a CMG though so I don't make the rules.

Plus FPs in the ED are going to cost way more money than PAs.

 

[Lexdiamondz]

No one has said they can be as good as an EP attending after an FM residency. More like... working in the ED with reasonable back up and/or fast track. It's also theoretical as to what % of ED complaints a FP can manage. A well trained FP can certainly manage more than just 70% like suggested above... but certainly not 100% like you seem to think med students have implied.


Again, the true outrage is why you're okay with a midlevel working in the ED (with "supervison") but not an FP? How about a PA with 6 months exp who has barely any true supervision (realistic scenario)? Compared with an FP who did a very intense residency with lots of elective time in the ED? Keep in mind the PA has like a month of "training" in the ED. If it's an NP, they probably have zero training. Yet you're fine with them?


Here's a nice thread outlining why your pro-midlevel anti-doctor stance is incredibly dangerous: Family Med + Emergency Medicine Fellowship

What's the point of hiring an attending physician if they require "reasonable backup" to do their job? That requires two attendings now - when you can get a PA or NP to do the same thing for much cheaper. You're railing against the use of midlevels in the ED and yet you're asking why an attending physician can't fill the role of midlevel in the ED. Use your brain.

 

[d2305]

I can't think of any patient a FP couldn't handle after a couple of months in the ER. Some rural EDs are staffed by solo FPs or worse.

 

[VA Hopeful Dr]

What's the point of hiring an attending physician if they require "reasonable backup" to do their job? That requires two attendings now - when you can get a PA or NP to do the same thing for much cheaper. You're railing against the use of midlevels in the ED and yet you're asking why an attending physician can't fill the role of midlevel in the ED. Use your brain.

That's a fair point. I for one didn't spend 7 years in medical education to be supervised by anyone.

Egotistical? Absolutely. Likely a very very common thought among doctors? Also absolutely.