EM and PEM

[Powdermonkey]

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So, I was talking to one of the clinicians at school about residency and fellowship opportunities yesterday, and an interesting topic came up. Since I'm interested in pedsEM and EM, I have been looking at residency and fellowship opportunities for both. He said he has some friends up at the pediatric program as well as the pediatric emergency medicine fellowship up at University of Minnesota and that they have a fellowship opportunity available for pedsEM that is 4 years instead of 3 and you have to opportunity to be boarded in adult EM as well as peds EM.

So you'd do:

peds --> pedsEM (4 yrs instead of the normal 3) --> peds EM boarded and eligible for adult EM BC/BE

I looked around on ERAS and the UofMN fellowship site and I couldn't find any information to back this up. Is he mistaken, or is there some hidden information that I'm just not looking in the right spot for?

Thanks!

 

[turtle md]

As far as I know, the only way to become ABEM board certified in EM is to finish an accredited EM residency. I don't know how doing a peds residency and then a peds EM fellowship would work. Your other option is to do an EM residency and then a peds EM fellowship.

 

[Powdermonkey]

As far as I know, the only way to become ABEM board certified in EM is to finish an accredited EM residency. I don't know how doing a peds residency and then a peds EM fellowship would work. Your other option is to do an EM residency and then a peds EM fellowship.

Yeah, thats what I was figuring, I just didn't know if I was missing something. Thanks, Turtle.

 

[southerndoc]

EM residency + peds EM fellowship is a year shorter than peds + peds EM fellowship.

 

[deleted109597]

So you'd do:

peds --> pedsEM (4 yrs instead of the normal 3) --> peds EM boarded and eligible for adult EM BC/BE

No.

* Pediatric trained residents need to complete a 3 year program
* Emergency Medicine trained residents need to complete a 2 year program

http://www.med.umn.edu/peds/em/education/home.html

 

[Apollyon]

EM residency + peds EM fellowship is a year shorter than peds + peds EM fellowship.

About half of the PEM fellowships are 3 years across the board (so as to maintain equity between those who hit it from Peds and EM).

 

[jbar]

I thought there were Peds/EM joint residencies where you did the whole thing in 5 years and were board BE/BC in both. Though you come out boarded in Peds and in EM but not in emergency pediatrics.

 

[Apollyon]

I thought there were Peds/EM joint residencies where you did the whole thing in 5 years and were board BE/BC in both. Though you come out boarded in Peds and in EM but not in emergency pediatrics.

There are, and you are correct. That is the result of some dealing approx 30 years ago.

It's rather ironic to do EM/Peds, but then to want BE/BC in Peds EM, to do 2/3 more years. Or, alternatively, to be triple boarded in as little as 7 years is only trumped by IM/EM/CC and IM/Pulm/CC, at 6 years each.

 

[DeLaughterDO]

There are, and you are correct. That is the result of some dealing approx 30 years ago.

It's rather ironic to do EM/Peds, but then to want BE/BC in Peds EM, to do 2/3 more years. Or, alternatively, to be triple boarded in as little as 7 years is only trumped by IM/EM/CC and IM/Pulm/CC, at 6 years each.

Triple boarded? Sounds like a lot of work and a lot of different masters to try to appease, to me. I'll just stick with my two, the wife and ABEM

 

[Apollyon]

Triple boarded? Sounds like a lot of work and a lot of different masters to try to appease, to me. I'll just stick with my two, the wife and ABEM

There's a guy at Columbia-Presbyterian with 4 - FOUR - BC's - IM, EM, Pulm, and CC. He can admit to the service end of the month, and then be the CC attending for the same pt in the unit at the beginning of the next.

 

[jbar]

Isn't pulm/CC one fellowship?

 

[Arcan57]

A lot of fellowships combine CC and pulmonary, but they are two separate boards. If I remember correctly, just CC is only a two year fellowship and CC/pulmonary is 3 years. Heme/onc is similar in that it's one fellowship but two separate boards. So a med/peds resident doing a combined adult/peds heme/onc fellowship could be sextuple boarded.

 

[Apollyon]

Pulm is 2 years, and CC is 2 years. It's the same for heme and onc. However, if you combine either of the 2 (which is normally done), it's 3 years' each. (Kind of the way Med/Peds is 3 years' each, or 4 if done together, which is actually kind of the best deal among combined residencies/fellowships.)

 

[MossPoh]

There's a guy at Columbia-Presbyterian with 4 - FOUR - BC's - IM, EM, Pulm, and CC. He can admit to the service end of the month, and then be the CC attending for the same pt in the unit at the beginning of the next.

We have a guy at the crappy little hospital in the town I grew up in with 4. IM, Pulm, Cards, and Interventional Cards. His patient list is insane and admits to having too many "dog tags", but is just a workaholic. I was exhausted following him around for a couple of days.

 

[diphenyl]

I though one doc I knew was crazy enough being dual boarded in IM and EM.


The peds EM route always goes like this:

peds----->peds em fellowship--> boarded in peds/ peds EM

EM -----> peds peds em fellowship---> boarded in adult EM/ peds EM

peds/ EM dual residency -> dual boarded adult EM and pediatrics but not peds EM

 

[MossPoh]

If one did Peds/EM is it REALLY necessary to do an actual fellowship for pediatric EM? I know it is one more thing to hang on the wall, but is there a significant enough increase in one's knowledge to make that a worthwhile fellowship?

 

[deleted6669]

I used to work with a doc who had 5 board certs:
did fp(1) and discovered he liked pulmonology so then did IM(2) and pulmonology(3). along the way worked a lot in the e.d. and tested for em(4) back when that was an option.
later got bored with em and went back and did anesthesiology(5). finished that and realized he hated working with surgeons so went back to em and retired 2 yrs ago as an em chief.

 

[dmitrinyr]

I used to work with a doc who had 5 board certs:
did fp(1) and discovered he liked pulmonology so then did IM(2) and pulmonology(3). along the way worked a lot in the e.d. and tested for em(4) back when that was an option.
later got bored with em and went back and did anesthesiology(5). finished that and realized he hated working with surgeons so went back to em and retired 2 yrs ago as an em chief.

So, this doctor did 9 years of residency training (3 for each FP, EM, Anes) and a total of about 11 years of training? Was this guy bored easily or liked getting payed like a resident? I've seen many people do an IM or FP or Peds residency just to realize that they like EM and then did an EM residency but I've never seen a person who did 3 different residencies. I'm just curious, how long did this doctor practice EM? Was it longer than 11 years?

To MossPoh, I believe that the Peds/EM combined residency is 5 years and I'd think that would give you equivalent Peds EM exposure as compared to 3 years of EM + 2 year Peds EM fellowship. Possibly the Peds/EM combined might give you more floor months than you would want and less EM months, although I'd think it should be enough to feel confident of your knoledge in the end.

 

[deleted6669]

He got some credit from fp for IM and some credit from IM/Pulmonology for anesthesia. don't know how much. he had to have done 5 yrs of em before 1986 to be eligible for the em boards. I think he did 5 yrs of so of em before going back to anes. then did another 10 or so after finishing it. so he probably did 20 yrs years of em out of 40 years working in medicine(including residency time). he was married to an internist so I don't think money was a big issue for them.

 

[deuist]

I had an attending in med school who was neuro, ophtho, and family.

 

[diphenyl]

If one did Peds/EM is it REALLY necessary to do an actual fellowship for pediatric EM? I know it is one more thing to hang on the wall, but is there a significant enough increase in one's knowledge to make that a worthwhile fellowship?

Although it is true that there is no substantial gain in knowledge it will be hard to find employment without being fellowship trained. regardless of an EM or peds background, many peds EM departments want someone who is somehow fellowship trained in that specialty. this is the same reasoning why a peds EM group woudln't take a pediatrician right out of residency without a fellowship same goes for EM trained.

It's just like someone who wanted fill an attending position to teach emergency ultrasound at a residency program. Although all EM residents coming out are at least familiar with most of the aspectes of US in the ED, its perfectly reasonable to look for someone fellowship trained if they are looking for an attending who is expected to be an expert on it.

 

[Apollyon]

Although it is true that there is no substantial gain in knowledge it will be hard to find employment without being fellowship trained. regardless of an EM or peds background, many peds EM departments want someone who is somehow fellowship trained in that specialty. this is the same reasoning why a peds EM group woudln't take a pediatrician right out of residency without a fellowship same goes for EM trained.

Where do you get your data? The only places I know that have dedicated Peds EDs are bigger places, and, if someone wants to work any amount of time in the Peds ED, they welcome it. And, idiosyncratically, the "Women's and Children's" Hospital here now has adult and peds EM people in the ED (it's not attached to an adult hospital).

Rare indeed is the group that can afford to turn away an EM/Peds trained person "because there is no fellowship".

 

[diphenyl]

Where do you get your data? The only places I know that have dedicated Peds EDs are bigger places, and, if someone wants to work any amount of time in the Peds ED, they welcome it. And, idiosyncratically, the "Women's and Children's" Hospital here now has adult and peds EM people in the ED (it's not attached to an adult hospital).

Rare indeed is the group that can afford to turn away an EM/Peds trained person "because there is no fellowship".

Do a search for Peds EM job. An overwhelming majority specifically state they want a fellowship trained applicant

 

[Hamhock]

I had an attending in med school who was neuro, ophtho, and family.

in what order? (were the residencies)
HH

 

[Apollyon]

Do a search for Peds EM job. An overwhelming majority specifically state they want a fellowship trained applicant

As the old rubric goes, "The best jobs are not advertised". Advertised jobs are frequently headhunters, or they can't land an applicant by word of mouth.

I'm just sayin'. They state a "fellowship trained applicant", but they're advertising - which means they're reaching.

 

[Stitch]

Where do you get your data? The only places I know that have dedicated Peds EDs are bigger places, and, if someone wants to work any amount of time in the Peds ED, they welcome it. And, idiosyncratically, the "Women's and Children's" Hospital here now has adult and peds EM people in the ED (it's not attached to an adult hospital).

Rare indeed is the group that can afford to turn away an EM/Peds trained person "because there is no fellowship".

This is my experience as well. There just aren't enough peds-->peds EM trained people out there to cover everything. We have a couple of adult EM--> peds people in our dedicated pediatric ED, and we'd take more. We also take people straight out of peds residency (usually out of our own program) for double coverage.

This scenario may change as more graduate from peds-->peds EM, but for now, there are jobs out there.

 

[deuist]

in what order? (were the residencies)
HH

I'm not sure. He's the driving force behind the Made Ridiculously Simple Series.