EM as an FP

[drmdrmd]

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Are there many opportunities to work in an ED (full time) after an FP residency?

 

[JackADeli]

Are there many opportunities to work in an ED (full time) after an FP residency?

I hear there are. The issue is where you may want to live. I have known colleagues that do shifts in ERs regularly. I have known hospitals that even hire FM docs to be med-directors of ERs. There are staffing companies you can contract with too in order to get shifts at ERs.

 

[Rendar5]

you can in more rural areas, but I would not recommend it honestly in most cases but the lower acuity settings. It takes a lot of experience to become remotely comfortable with salvaging crashing patients on your own without depending on much backup. You'll only deal with one of these every now and then, sure, but most FP's I know aren't trained for them. I'm sure there will be exceptions though.

 

[thethom]

It takes a lot of experience to become remotely comfortable with salvaging crashing patients on your own without depending on much backup. You'll only deal with one of these every now and then, sure, but most FP's I know aren't trained for them. I'm sure there will be exceptions though.

I manage crashing patients every day in residency (on the inpatient service we carry the Code Blue pager for the entire 550 bed hospital). I would beg to differ that a crashing patient is relatively easy to manage as its mostly ACLS cookie cutter stuff. Even intubations are relatively easy, blade into vallecula, tube through cords...

On my ER rotation, the hardest part for me was learning that the ER is not meant for finding the solution to 90% of problems. Most stuff was triage, "bandaid until PCP visit", dispo. Its a trauma center but typically major traumas go to the surgical service (and after seeing plenty of trauma on surgery in school, wasn't that interested in it). Managing most problems is something that happens in the outpatient setting.

There are FM trained ED boarded (grandfathered in) docs working as full time EDPs in our ER as well, and Greensboro isn't rural.

Nowadays you can't get ED boarded with FM...same training today, but the bureaucratic roadblock does exist.

 

[Apollyon]

Even intubations are relatively easy, blade into vallecula, tube through cords...

Oh dear..."simple" and "easy" are not synonymous. I mean, I know how to throw a fastball - can I do it? Not to any effective end, at all. You want the pucker factor to go to 10? Have an unsecured airway. Remember "ABC" - Airway, Breathing, Circulation? First is "A". Without it, game over. Yogi Berra said "You see a lot just by looking". Ever looked yet and seen nothing? It's not easy all the time.

On my ER rotation, the hardest part for me was learning that the ER is not meant for finding the solution to 90% of problems. Most stuff was triage, "bandaid until PCP visit", dispo. Its a trauma center but typically major traumas go to the surgical service (and after seeing plenty of trauma on surgery in school, wasn't that interested in it). Managing most problems is something that happens in the outpatient setting.

What is emergency medicine? "The rapid recognition of sickness and health, and the resuscitation of the critically ill and injured." First prong is "rapid recognition of sickness and health", and the practical realization that most people seen in the ED are not "sick" per se, or, alternately, life-threateningly ill.

There are FM trained ED boarded (grandfathered in) docs working as full time EDPs in our ER as well, and Greensboro isn't rural.

Nowadays you can't get ED boarded with FM...same training today, but the bureaucratic roadblock does exist.

The EM practice track closed in 1989. The requirement was 7000 hours and 60 months in the ED (with 24 of those months consecutively) to be able to sit for the board. 21 years ago + 5 years in the ED + 3 years FM residency (called FP then) + 4 years of med school + 4 years of college, and start at 18 years old: 55 y/o today. I would guess that not a lot of FM grads in the 80s abandoned office practice to work full time in the ED (or else the AAFP would have stepped in and - oh, wait, they did - help form an EM specialty board). Indeed, there are around 5000 EM boarded but not EM-residency trained docs left in the US. I am thinking that, for many EM docs (EM trained or not), getting into their 50s is the time to think about retirement.

As for the same training, it is similar, but not the same. There is a lot of overlap, but, still, not identical. The most glaring difference is half or more of the months of EM residency are set in the ED. Much of the time in the ED is learning the ropes - not the generalities of CHF or lacerations or cerebral bleeds, but the specifics of the optimal first-line management and how to dovetail these patients into the appropriate specialists, instead of managing those patients by themselves (past the acute stage). Another difference is no continuity clinic. Although there is some functional continuity in the ED due to "frequent fliers", that is not the intent.

Medicine is a family, with medicine and surgery being parents, a lot of cousins, but EM and FM are siblings. You may look a lot like your brother, or be a lot like your sister, but you are not them.

I don't want sibling rivalry. It is not good, and, hopefully, in the end, we realize we're very closely on the same team.

 

[deleted87716]

^ Good post. 👍

 

[thethom]

Agreed as well, and excellent post apollyon.

EM, Acute generalists
FM, Chronic generalists
TONS of overlap.

 

[EdibleEgg]

To answer the original post, there are lots of opportunities. I don't see them dwindling anytime soon, but who knows. Ten years ago there were no EM trained docs here. Now the staff if 50/50. The opportunities also may not exist in the most ideal settings. All other things equal, the EM boarded doc will get the job over the FM boarded doc every time. I've been working part time in the ED for the past couple of years. Initially, I had no plans of doing any ER work, but picked up a few shifts at the desparate pleas of the administration. I enjoyed it (and the extra income) so much I kept going. Bottom line: the opportunity exists, and plenty of it, but if you want to be an ER doc do and EM residency.

 

[Rendar5]

I manage crashing patients every day in residency (on the inpatient service we carry the Code Blue pager for the entire 550 bed hospital). I would beg to differ that a crashing patient is relatively easy to manage as its mostly ACLS cookie cutter stuff. Even intubations are relatively easy, blade into vallecula, tube through cords...

I agree that ACLS crashing patients are among the easiest to manage. The crashing inpatient is a much different story than the crashing patient rushed in by their family or EMS with something other than cardiac arrest in the field, however, and after you've seen several of those and have to deal with difficult airways, difficult access issues, difficult trauma issues (taking the ATLS course one time simply isn't enough), you'll realize that's where the training really comes into play.

FM is one of the closest fields in medicine to EM, and vice-versa with tons of overlap. But there are aspects of each other's training that you simply don't get in today's training environment. And I say this with one of my favorite ED attendings being an FP originally 30 years ago. And one of the best senior residents I worked with be someone who completed their FM residency and then came to our program to do a 2.5yr residency

 

[FlameBoy]

thethom

M.D. RUSM c/o 2009
Step 1: 260/99
Step 2CK: 236/98
License: Active

Dude, what's with the scoresheet? Aren't you a resident?

 

[thethom]

Dude, what's with the scoresheet? Aren't you a resident?

Been posting here since my med school days, the sig just stuck. Plus, worked hard and I'm proud of em...

 

[Coastie]

I manage crashing patients every day in residency (on the inpatient service we carry the Code Blue pager for the entire 550 bed hospital). I would beg to differ that a crashing patient is relatively easy to manage as its mostly ACLS cookie cutter stuff. Even intubations are relatively easy, blade into vallecula, tube through cords...

On my ER rotation, the hardest part for me was learning that the ER is not meant for finding the solution to 90% of problems. Most stuff was triage, "bandaid until PCP visit", dispo. Its a trauma center but typically major traumas go to the surgical service (and after seeing plenty of trauma on surgery in school, wasn't that interested in it). Managing most problems is something that happens in the outpatient setting.

There are FM trained ED boarded (grandfathered in) docs working as full time EDPs in our ER as well, and Greensboro isn't rural.

Nowadays you can't get ED boarded with FM...same training today, but the bureaucratic roadblock does exist.

How many intubations have you done?

EM is easy..until you do enough to realize that it's not.

 

[deleted87716]

EM is easy..until you do enough to realize that it's not.

The same could be said of primary care.

 

[Coastie]

The same could be said of primary care.

I completely agree.

 

[microscp2]

Been posting here since my med school days, the sig just stuck. Plus, worked hard and I'm proud of em...

Thethom ! put your scores back up ! I agree, you have worked so hard for those, who cares that you are a resident. At least I don't, it is so nice to see that in Family Medicine, you will get applicants that are high scorer too.

 

[december07]

i manage crashing patients every day in residency (on the inpatient service we carry the code blue pager for the entire 550 bed hospital). I would beg to differ that a crashing patient is relatively easy to manage as its mostly acls cookie cutter stuff. Even intubations are relatively easy, blade into vallecula, tube through cords....

hahaha....