EM fellowship after IM or FP?

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illegallysmooth

illegallysmooth

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I have recently discovered the existance of a couple EM fellowships open to those who were residency trained in IM or FP.

How do you feel about this? Do you think the job selection for those with an EM fellowship vs. EM residency would be narrower or more competitive? Are they eligible to sit for EM boards?

I'm confused as to why the FREIDA search doesn't have an option to search for these types of fellowships, only traditional sub-specialties. Perhaps they are just that uncommon?
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This topic has been discussed previously. EM fellowships do not lead to being able to sit for the ABEM boards. There is a competing board that does allow non-EM residency trained physicians to sit. The title bestowed is BCEM (board-certified in emergency medicine). In places that traditionally hire IM/FP/Med-peds docs to staff the ED, being BCEM may help your competitiveness. In places that only hire residency trained EPs or require board certification (which most EPs take to mean ABEM, the BCEM will be looked down upon as a diploma mill degree.
 
You won't be as well trained and you won't be as competitive for jobs. Worse, how will it feel when you show up at your EM job, for which you are incompletely trained and acquired via backdoor certification, and a real emergency rolls through the door - one that you aren't trained to manage?
 
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Thanks for your input. Based on your responses I think I'm going to be crossing this pathway off the list. My issue is that I am considering the NHSC scholarship because I am interested in IM, Peds and OB (and will have a HUGE amount of debt)...but I also have 4 years of experience in the ER and I don't want to exclude EM from my options at this point.
 
You can always go for loan repayment later. You won't know what you really want to do until you experience it in 3rd-4th years of med school. Many of my classmates who were gung ho, wannabe surgeons ended up in FP and vice vs.
 
illegallysmooth said:
I deeply appreciate you taking the time to do this, but had you actually clicked on the results of the search you would find exactly ONE helpful post from six years ago.
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Really? I found quite a few quality posts that answered your questions.

Most hospitals now require EM board certification, and the only way to get that is to do an EM residency.
 
To the OP, I wanted to pipe in and help you understand why you have received a bit of snark here. EM residency trained docs feel strongly that over the last 20 or so years since the advent of EM residencies, a unique body of knowledge and skills have developed which are best learned in an EM residency.

To suggest that there are alternative shorter (easier) routes to obtain this knowledge and skill set is profoundly insulting, hence the ire of some other posters on here.

It is analogous to midlevel providers who suggest they are equivalent to physicians even though they have less training.
 
I trained in my EM residency with somone who had done a FM residency followed by one of those EM fellowships. He was wise enough to realize that his fellowship left him very poorly prepared to practice EM, so he did a EM residency after the fellowship.

If you want to practice in a particular area of medicine, you really need to get the proper, full training. Anything less will leave you ill-prepared and open you up to significant malpractice liability (you're held to the same standards as someone who completed a full residency in the specialty, even though you did not).
 
I practice with a couple of FP docs. One was in practice for oer 20 years, doing OB and admitting to the hospital (ICU,peds, etc.). The other actually got into an ER residency, but for family reasons, had to transfer to an FP program in another city after one year in ER.

They do just fine. I think they are less conservative than I am (do less CTs, fewer troponins, and admit fewer BS abdominal pain and chest pain. The fact is that there is a huge shortage of ER docs in rural locations and that isn't going away anytime soon. I'd rather have an FP working alongside of me who has done a fellowship in ER than an NP or PA.

Just like everything in life, not all FP, NP, or PAs are alike, or ER docs for that matter. You get out of your education what you put into it.

Not all job markets are going to be open to you and you are really going to have to be willing to go and work in places that you wouldn't prefer to live in.

Working in ER is going to be more profitable for you than working in FP. FP is really a poor business/education model. There are few procedures and you spend so much time in residency on OB that other areas of your training really suffer (ICU, anesthesiology, cardiology, pediatrics etc.)

Thoughts?
 
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kungfufishing said:
You won't be as well trained and you won't be as competitive for jobs. Worse, how will it feel when you show up at your EM job, for which you are incompletely trained and acquired via backdoor certification, and a real emergency rolls through the door - one that you aren't trained to manage?
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So, let's say in total that someone board certified in family practice completes a one year EM fellowship somewhere. Board certified or not, I could see it possible that once completed the FP may then have up to 18 months of EM experience with required EM rotations during residency as well as some call exposure.

An EM resident gets how many months of EM exposure out of a 36 month residency? I know they'd have to spend time rotating through some other things that FPs would also be exposed to.

I just don't see how FPs would be that much at a disadvantage. Where I come from the emergency department was staffed with FP trained physicians, and they always seemed to do a good job. Granted, I was in no position to rate their work having been only in a position of paramedic which was my weekend "hobby job" at the time, and this was several years ago.

If one had no desire to live and work in "large" cities then an FP residency may serve well for someone wishing to staff a hospital emergency department. Correct or not?
 
ArkansasRanger said:
If one had no desire to live and work in "large" cities then an FP residency may serve well for someone wishing to staff a hospital emergency department. Correct or not?
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Not.

You might be able to get away with it, but it will in no way serve you well. And as the number of residency trained, BCEM docs increases, the number of EDs staffed w/ FPs and IM docs will decrease asymptotically towards zero.

And I don't know what the ABEM requirements are, but our EM residents do 26-28 months in the ED (between 2 Peds EDs and 3 Adult EDs). They also do a SICU month, a PICU month, 2 MICU months, a month of IM wards, a month of OB, 2 months of surgery and a month of Gas.

So no...if you want to work in the ED, do an EM residency.
 
gutonc said:
Not.

You might be able to get away with it, but it will in no way serve you well. And as the number of residency trained, BCEM docs increases, the number of EDs staffed w/ FPs and IM docs will decrease asymptotically towards zero.

And I don't know what the ABEM requirements are, but our EM residents do 26-28 months in the ED (between 2 Peds EDs and 3 Adult EDs). They also do a SICU month, a PICU month, 2 MICU months, a month of IM wards, a month of OB, 2 months of surgery and a month of Gas.

So no...if you want to work in the ED, do an EM residency.
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I must admit the environment of the emergency department is more appealing for me, however, from "just reading" the FP residencies always seemed more interesting to me due to their generality. I did fail to clearly express my thoughts earlier. What I meant to say was would an FP residency with fellowship in EM (regardless of boards) not be suitable? My mistake.

Granted, none of this really matters because I'm years away from it all anyway.
 
by generality I think he meant "breadth".
what other specialty can train you to do such a wide scope of practice?
manage pts from birth to death as outpts or impts, deliver babies(including c-sections), any office based procedure you care to learn including colonoscopy, derm procedures, treadmills, etc, work in rural er's, urgent care ctrs, solo rural positions, etc
I can see his point. if I ever went back for the md I would probably do fp/em or straight fp but do a really cowboy unopposed program like ventura or contra costa where the residents basically run the entire hospital on all services except surgery where they first assist.
 
ArkansasRanger said:
I must admit the environment of the emergency department is more appealing for me, however, from "just reading" the FP residencies always seemed more interesting to me due to their generality. I did fail to clearly express my thoughts earlier. What I meant to say was would an FP residency with fellowship in EM (regardless of boards) not be suitable? My mistake.

Granted, none of this really matters because I'm years away from it all anyway.
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The answer remains the same however. To practice EM, train in EM. To practice FM, train in FM. Want to do both? There are a couple (literally...just 2) EM/FM residency programs and there are a dozen or so IM/EM programs out there...do that.

Don't bring your chronic DM2 care knife to a septic shock gunfight. Or your trauma code knife to a well-baby exam gunfight for that matter.
 
gutonc said:
The answer remains the same however. To practice EM, train in EM. To practice FM, train in FM. Want to do both? There are a couple (literally...just 2) EM/FM residency programs and there are a dozen or so IM/EM programs out there...do that.

Don't bring your chronic DM2 care knife to a septic shock gunfight. Or your trauma code knife to a well-baby exam gunfight for that matter.
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True. Keep in mind I'm only speculating here and am nothing other than a layman hoping to change careers and get out of state law enforcement.

Interesting side note, I have in my life had the opportunity to say "I know you didn't just bring that knife to a gun fight."
 
emedpa said:
and recently I was able to say" that's not a dance move, that's a seizure"
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Yeah, but you did it with a Sierra Mist in your hand, didn't you?

Take care,
Jeff
 
Another thing to think about is that if you aren't practicing family medicine, you aren't going to do as well on the family medicine boards.

You think, "I can just focus on learning EM when in FP residency, and I'll just practice in an ER and never have to worry about catch-up vaccination schedules, treatment of cholesterol, diabetes, work-up of obscure rheumatologic conditions, dermatology, and honing OB skills."

Then you get out of residency, start working in an ER and spend all of your spare time learning ortho, anesthesia, trauma, and procedures that you've never seen, let alone done. You never review the vast majority of topics that you will encounter on your FP boards (the single broadest knowledge base of any specialty).

You might end up in the situation that one of my colleagues is in where the hospital requires board certification, but you can't pass your boards. Most hospitals require some kind of board certification, even if you aren't board certified in ER.

You could spend 10 years in an attempt to take an end-around route so you can practice in an ER, then you get fired because you can't pass your FP boards.

You are now left with the only option of practicing FP, something you loathe, and haven't put an ounce of effort into learning for 6 years. You can't practice ER, and you probably shouldn't be practicing in FP. A bad place to be.

Moral of the story... You should start a residency with the goal of practicing in that area of medicine.
 
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Other than the peds pathway ending in board certification, what is the difference between doing peds residency ---> pedi EM fellowship and FM residency ----> EM fellowship? Why does one result in competent caregivers, and not the other? Are the pedi EM fellowships more rigorous, or is it just that the patient base can be so simple?
 
blue shift said:
Other than the peds pathway ending in board certification, what is the difference between doing peds residency ---> pedi EM fellowship and FM residency ----> EM fellowship? Why does one result in competent caregivers, and not the other? Are the pedi EM fellowships more rigorous, or is it just that the patient base can be so simple?
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My understanding is the Peds pathway consists of 3 years of Pediatrics (of which you can be boarded) plus 3 additional years of EM. This allows you to be boarded in pediatrics and pediatric EM (recognized by the ABEM).

The FM path is 3 years FM (board eligible) followed by 1-2yrs of fellowship allowing board certification in FM and EM via the BCEM, which is not highly regarded among the EM community and not recognized by the ABEM.
 
gro2001 said:
I think its sort of that, except I would not say 'simple' but just not as sick. And there are EM docs out there who would say similar things about peds+EM fellowship docs as they do about FM+fellowship docs.
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As pointed out above, the two fellowships are in no ways equivalent. Peds EM fellowships tend to be in cities with level 1 trauma centers as well as ridiculously high volumes with a decent percentage (for kids, anyway) of tertiary care/referral center cases.

FM+EM fellowships tend to be in smaller hospitals with lower volumes and proportionally lower acuity. The decreased acuity combined with the markedly shorter training period means inferior training.

I'd much rather have my son seen by a ped/peds EM doc than a straight EM doc, and I'd much rather have my parents seen by a EM doc than a FM/fellowship trained doc. And I'm not alone on this one.
 
http://docwhisperer.wordpress.com/category/er-docs/

full text available there, i would note this is comparing EM residency docs with non EM residency docs, it doesnt even account for the added fellowship concept, which would have the non EM residency docs even further trained.

"In fact, all of the certified ABPS physicians are convinced they would also pass the ABEM board examination, just like their grand-fathered colleagues. Dwight Collman [ABEM certified], arguably the best ER Board Preparer in the country, did not do a residency in ER medicine. No one doubts his fund of knowledge nor his likely skill in the actual practice of EM."
 
topscorer said:
http://docwhisperer.wordpress.com/category/er-docs/

full text available there, i would note this is comparing EM residency docs with non EM residency docs, it doesnt even account for the added fellowship concept, which would have the non EM residency docs even further trained.
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Did you actually read the abstract? First of all, the percentage of ASA in AMI was ridiculously low in both groups which makes me question the validity of their entire data set. Also, using hospital core measures (especially the ones chosen) as a proxy for physician skill is sketchy at best. I'll assume that an IM doc could follow core measures for diseases that are their bread and butter. I'd also assume that most PEOPLE would give someone with a long bone fracture analgesia. Now if the study was able to show equivalence in missed MI, missed ectopic, missed appy, cosmetic appearance of laceration repair, success in shoulder reductions, sucess in intubation and central line placement; while maintaining equivalent pts/hr with the same acuity mix that would be another story.

"In fact, all of the certified ABPS physicians are convinced they would also pass the ABEM board examination, just like their grand-fathered colleagues.
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How nice for them. You see why this isn't an intellectually rigourous argument, correct?

Dwight Collman [ABEM certified], arguably the best ER Board Preparer in the country, did not do a residency in ER medicine. No one doubts his fund of knowledge nor his likely skill in the actual practice of EM."
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He's ABEM certified. His success tells us nothing about the quality of APBS certified physicians. Furthermore, the docs that are practicing EM that just missed grandfathering have been in practice for over a decade. That is not the same cohort as people that are just finishing their non-EM residency and then taking the ABPS exam.

Come back when you have relevant data to present.
 
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