Does anyone know if more combined EM programs are being added?

[riskybizness]

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Recently found out about IM/EM programs and Peds/EM programs. Currently there are only a few of these. Does any one know of schools that may actively be working towards having this program in the upcoming years. I'm a current 1st year.

Thanks!

 

[KinesiologyNerd]

Anes/EM is coming

 

[Crayola227]

so many combined programs I just don't see how it all ends up useful

most ED docs I've asked about IM/EM think it's crazy

 

[WilliamofOckham]

Who cares? If EM is what you want to do, don't waste your time with combined programs. Get to that sweet, sweet paycheck.

 

[riskybizness]

And to clarify, I specifically want to know if any school is actively working towards having more of peds/EM programs.

Thanks!

 

[doc05]

combined programs offer extra time in training without tangible benefit. doubtful that anyone here would know. also doubtful that any med school actually benefits from a combined program. best to check with the acgme about newly accredited programs.

 

[dadaddadaBATMAN]

Recently found out about IM/EM programs and Peds/EM programs. Currently there are only a few of these. Does any one know of schools that may actively be working towards having this program in the upcoming years. I'm a current 1st year.

Thanks!

If you haven't completed at least part of third year, I wouldn't get in too much of a tizzy yet about which programs have combined options. It sounds like a fantastic idea as a 1st/2nd year, but the reality of clinical practice is pretty different between specialties. There are limited places where it makes sense (intention to practice critical care, especially pediatric critical care, as part of your practice). However, even then there are probably more efficient means to your goals.

Just the thoughts of someone who was intensely interested in EM/IM until I experienced both fields. Pace and thought process are drastically different: it might be good for critical care to have a heavier IM background, but it's not worth 5 years of continuity clinic, rounding, and dealing with rocks on the wards.

 

[Brahnold Bloodaxe]

I'd prefer they stopped adding any new EM programs for a good long while. The explosion in EM residency spots in recent years has been unprecedented, and I worry that "sweet sweet paycheck" will not be quite so sweet once the increased supply starts flooding the job market, especially since this is a specialty controlled by a few large corporate groups that view physicians as a completely replaceable commodity. Keeping supply in check is the only leverage physicians enjoy in that specialty.

With that said, if they're going to insist in continuing to add spots, better that these spots be "combined" spots. Heck, why not throw a combined neurosurgery-cardiology-EM track into the mix? It will keep some trainees off the market longer and buy us some time to make hay while the sun shines.

 

[andrek82]

And to clarify, I specifically want to know if any school is actively working towards having more of peds/EM programs.

Thanks!

I'm not aware of any specific schools adding compound peds/em, but the route of either peds or em followed by the opposite fellowship is becoming more valued for peds ed's, at least in the northeast when I was interviewing. I interviewed for med peds, and most places with a dedicated peds ed talked about peds EM trained faculty as a selling point.

 

[URHere]

I also interviewed for Med/Peds, but did look briefly at peds/EM. If I remember correctly, one major downside is that peds/EM graduates are not eligible to sit for pediatric EM boards...meaning that if you want that, you would need to pursue a dedicated fellowship anyway, despite the longer residency training.

Obviously this isn't a problem for Med/EM because both are residency-level board certifications rather than fellowship-level, but it's food for thought.

 

[dadaddadaBATMAN]

I'd prefer they stopped adding any new EM programs for a good long while. The explosion in EM residency spots in recent years has been unprecedented, and I worry that "sweet sweet paycheck" will not be quite so sweet once the increased supply starts flooding the job market, especially since this is a specialty controlled by a few large corporate groups that view physicians as a completely replaceable commodity. Keeping supply in check is the only leverage physicians enjoy in that specialty.

With that said, if they're going to insist in continuing to add spots, better that these spots be "combined" spots. Heck, why not throw a combined neurosurgery-cardiology-EM track into the mix? It will keep some trainees off the market longer and buy us some time to make hay while the sun shines.

So, some thoughts.

1. Supply for most things in medicine is heavily regional. If you're willing to live in the places that pay it, you'll make damn good money well into the future.

2. EM is expanding because it has only existed as a specialty for about thirty years. Even 10-15 years ago having a fp doc practicing in a relatively major population center was not that uncommon.

 

[Brahnold Bloodaxe]

So, some thoughts.

1. Supply for most things in medicine is heavily regional. If you're willing to live in the places that pay it, you'll make damn good money well into the future.

2. EM is expanding because it has only existed as a specialty for about thirty years. Even 10-15 years ago having a fp doc practicing in a relatively major population center was not that uncommon.

I see what you're saying but I think there are a few things to be cautious about. First, only a certain percentage of EDs across the country are high acuity and high volume and can properly leverage EM boarded docs. Logic would have it that as the number of EM boarded docs has increased over the last couple decades, they have started filling out EDs from the top (ie busy and high acuity) down. Only by working at a busy place can an EM doc make 300k+. If the end goal is to staff every ED across the country by EM boarded docs, then those docs are going to have to accept much lower salaries, because sleepy rural and suburban emergency departments aren't going to throw out their 200k fm docs and replace them with 350k EM docs.

Secondly, as you noted, EM is a very new specialty, and significant numbers of grads haven't entered the job market except for very recently. This means there are few physicians leaving the field each year, so every new graduating class of residents is almost entirely a net addition to the labor pool. The job market is holding steady so far, but if it ever does overshoot, it's going to overshoot big league and get worse and worse each year for a very long time. I think caution is warranted.

 

[HelpPleaseMD]

I agree that EM/IM makes no sense. more years of training without much tangible benefit. Perhaps EM/CC for variety. going between the ED and general medical floors will be a quick recipe for burn out. headache/socialwork/ abdominal pain/chest pain galore

 

[dadaddadaBATMAN]

I see what you're saying but I think there are a few things to be cautious about. First, only a certain percentage of EDs across the country are high acuity and high volume and can properly leverage EM boarded docs. Logic would have it that as the number of EM boarded docs has increased over the last couple decades, they have started filling out EDs from the top (ie busy and high acuity) down. Only by working at a busy place can an EM doc make 300k+. If the end goal is to staff every ED across the country by EM boarded docs, then those docs are going to have to accept much lower salaries, because sleepy rural and suburban emergency departments aren't going to throw out their 200k fm docs and replace them with 350k EM docs.

Secondly, as you noted, EM is a very new specialty, and significant numbers of grads haven't entered the job market except for very recently. This means there are few physicians leaving the field each year, so every new graduating class of residents is almost entirely a net addition to the labor pool. The job market is holding steady so far, but if it ever does overshoot, it's going to overshoot big league and get worse and worse each year for a very long time. I think caution is warranted.

I can understand the fear, but I'm not sure it reflects reality. The rural shops are actually the exact ones that are offering ridiculous sums of money for EM boarded docs right now: sleepy little places will offer $X000 to cover an eight hour shift locum tenens. You can read about it in the EM forums. I also know a number of docs personally who get multiple calls and emails daily tryin to recruit them for similar deals. They can't get docs out there.

EM physicians aren't only useful in high acuity places with lots of trauma. If anything, that's where they are the least useful because there is a depth of specialty coverage.

That just tends to be where they train because it allows them to see a full range of the pathology they need.

Additionally, EM docs work very few hours relative to other specialties, with good reason. The Emergency department is an extremely busy, high liability place. That's even true out in the burbs. It's difficult to work very many hours under those conditions. That further restricts the supply.

They also tend to retire and burn out young.

 

[kenjixshadow]

If the end goal is to staff every ED across the country by EM boarded docs, then those docs are going to have to accept much lower salaries, because sleepy rural and suburban emergency departments aren't going to throw out their 200k fm docs and replace them with 350k EM docs.

This is inaccurate. I have never seen an advertisement where FM docs are offered a lower rate than EM docs. I have, however, seen many job ads specify that they will only take EM BC/BE docs. These shops don't "throw away" their established FM docs, but they don't hire non-boarded EM docs.

Secondly, as you noted, EM is a very new specialty, and significant numbers of grads haven't entered the job market except for very recently. This means there are few physicians leaving the field each year, so every new graduating class of residents is almost entirely a net addition to the labor pool. The job market is holding steady so far, but if it ever does overshoot, it's going to overshoot big league and get worse and worse each year for a very long time. I think caution is warranted.

A majority of old EPs don't leave the field, but they will work less hours, or do a fellowship, and eventually go part-time. That simply translate to more newly graduates need to be hired. You also haven't take in account that our population is aging and growing. More ERs are popping up left and right for a reason. Stop being neurotic. If EM is in trouble, you will see Birdstrike blow the whistles in EM forum.

 

[riskybizness]

This is inaccurate. I have never seen an advertisement where FM docs are offered a lower rate than EM docs. I have, however, seen many job ads specify that they will only take EM BC/BE docs. These shops don't "throw away" their established FM docs, but they don't hire non-boarded EM docs.

A majority of old EPs don't leave the field, but they will work less hours, or do a fellowship, and eventually go part-time. That simply translate to more newly graduates need to be hired. You also haven't take in account that our population is aging and growing. More ERs are popping up left and right for a reason. Stop being neurotic. If EM is in trouble, you will see Birdstrike blow the whistles in EM forum.

What are EPs?

And what's BC/BE?

 

[Warderino92]

BC/BE means board certified or board eligible. In other words you need to be eligible to take the exam or have attained your board certification in emergency medicine to work there. I assume EP was referring to emergency physician.

 

[FrkyBgStok]

This is inaccurate. I have never seen an advertisement where FM docs are offered a lower rate than EM docs. I have, however, seen many job ads specify that they will only take EM BC/BE docs. These shops don't "throw away" their established FM docs, but they don't hire non-boarded EM docs.

not sure where you are, but where i am, there is an ED in town completely staffed by FM docs (as it is at a hospital with an unopposed FM residency), an ED with only EM docs, and an ED with mostly EM docs but a few FM docs, and every single one I have ever talked to knows very well that the FM docs working in the ED make significantly less than EM docs in the same ED. Sure they don't advertise a difference, but there is one. in addition, the rural places say they pay x and if you calculate it out, it is usually based on the FM rate. And many shops do in fact "throw away" there FM docs. it happened in the shop that only has EM docs now.

this is the same for pediatricians working in the ED vs Peds EM boarded docs. The pediatricians are annoyed because they make a lot less.

 

[dadaddadaBATMAN]

not sure where you are, but where i am, there is an ED in town completely staffed by FM docs (as it is at a hospital with an unopposed FM residency), an ED with only EM docs, and an ED with mostly EM docs but a few FM docs, and every single one I have ever talked to knows very well that the FM docs working in the ED make significantly less than EM docs in the same ED. Sure they don't advertise a difference, but there is one. in addition, the rural places say they pay x and if you calculate it out, it is usually based on the FM rate. And many shops do in fact "throw away" there FM docs. it happened in the shop that only has EM docs now.

this is the same for pediatricians working in the ED vs Peds EM boarded docs. The pediatricians are annoyed because they make a lot less.

It depends on the location and the case. I know FM guys who have worked for thirtyish years in EM, and they aren't getting dropped (or payed any less) than a typical ED guy.