EM/FM combined residency format announced

[BKN]

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The ABEM and ABFM announced 3/24 that a new em/fm format. 5 year program.

"It is the position of ABEM and ABFM that combined trainig is sole recognized pathway for EM residents to train in FM and for FM residents to train in EM, other than completion of both categorical . . . residency programs accredited by ACGME."

Am I the first person to post this? Thought it would be all over the boards by now.

 

[trkd]

The ABEM and ABFM announced 3/24 that a new em/fm format. 5 year program.

"It is the position of ABEM and ABFM that combined trainig is sole recognized pathway for EM residents to train in FM and for FM residents to train in EM, other than completion of both categorical . . . residency programs accredited by ACGME."

Am I the first person to post this? Thought it would be all over the boards by now.

There was talk awhile back but I think this is the first confirmed report. It will probably infect the board shortly. I just read the guidelines. The question is, how long til a FP/EM program is ready to start up? Next match, following match?

 

[BKN]

There was talk awhile back but I think this is the first confirmed report. It will probably infect the board shortly. I just read the guidelines. The question is, how long til a FP/EM program is ready to start up? Next match, following match?

Gotta get inspected and approved by both RRCs. I'd think next year would be early, maybe the folowing.

 

[EctopicFetus]

BKN do you know or can you guess where these might pop up?

 

[JackBauERfan]

BKN do you know or can you guess where these might pop up?

Yeah I have a few friends that were really interested in EM, but felt better doing FM so that they have the option to just stop and do FM stuff.

 

[allendo]

Yeah I have a few friends that were really interested in EM, but felt better doing FM so that they have the option to just stop and do FM stuff.

Man I hope this works out so I can apply for the D.O. and M.D. positions

 

[trkd]

Gotta get inspected and approved by both RRCs. I'd think next year would be early, maybe the folowing.

🙁 ya breakin ma heart. I would have actually considered it. I think it is a sweet combo.

 

[allendo]

🙁 ya breakin ma heart. I would have actually considered it. I think it is a sweet combo.

Hell yes it's a sweet combo, think of the medical knowledge you would have. You would be a real medical cowboy!

 

[JackBauERfan]

Hell yes it's a sweet combo, think of the medical knowledge you would have. You would be a real medical cowboy!

Medical cowboy? wow I want to be that, I bet you the best residencies would be in Texas hahaha.

 

[allendo]

Medical cowboy? wow I want to be that, I bet you the best residencies would be in Texas hahaha.

I've seen surgeons in Tex wearing knee high cowboy boots with their scrubs! Thats a real cowboy who can do surgery all day in boots.

 

[JackBauERfan]

I've seen surgeons in Tex wearing knee high cowboy boots with their scrubs! Thats a real cowboy who can do surgery all day in boots.

I really should visit texas sometime.

 

[allendo]

I really should visit texas sometime.

Take a road trip, combine southern Louisiana and Eastern Texas! Bam a dynamic combo. It's Like your on a different planet!

 

[BKN]

BKN do you know or can you guess where these might pop up?

No, . It is being touted as the thing for rural EDs, so it might tend to happen at smaller EM places in the country (like. . . uh . . . Mayo? )

I tend not to read the CORD list server, but I imagine it's been discussed there. You might you talk to the PD at your own school.

 

[BKN]

🙁 ya breakin ma heart. I would have actually considered it. I think it is a sweet combo.

This is gonna sound a little strange from somebody who likes to train retreads from FM and IM and who believes in knowledge for its' own sake, but I'd recommend against. Out of all those internists >5 and FPs>15 that I've trained, they are all practicing EM exclusively. Would this make it the $500K mistake?

 

[EctopicFetus]

No, . It is being touted as the thing for rural EDs, so it might tend to happen at smaller EM places in the country (like. . . uh . . . Mayo? )

I tend not to read the CORD list server, but I imagine it's been discussed there. You might you talk to the PD at your own school.

No PD at my school but its not necessarily something for me anyhow. I was just asking out of sheer curiosity. Thanks BKN!

 

[corpsmanUP]

This is gonna sound a little strange from somebody who likes to train retreads from FM and IM and who believes in knowledge for its' own sake, but I'd recommend against. Out of all those internists >5 and FPs>15 that I've trained, they are all practicing EM exclusively. Would this make it the $500K mistake?

I don't think its so much about the money but more about the knowledge. In all seriousness, a combined 5 year program with EM and FM simply makes a WAY more rounded and knowledgeable physician for the ED. Having been a PA in FM for many years, the knowledge in my opinion is invaluable. Of course it is an extra time commitment, and no I am not saying that 3 years of EM is not sufficient. I am just saying that now there is another option instead of choosing the 3 or 4 year EM route. I doubt many of these docs would ever do the FM route after the 5 years but it will make them better EM physicians for certain. For a young person, I think this is an incredible route and I would take it if it were available now, and if I was about 9 years younger.

 

[kungfufishing]

If you are only planning to work in the ED, what aspect of the FM knowledge base would improve your education sufficiently to make the combined training worthwhile? If you really want to work as a rural FM/ED physician I can certainly see the benefit.

 

[12R34Y]

I don't think its so much about the money but more about the knowledge. In all seriousness, a combined 5 year program with EM and FM simply makes a WAY more rounded and knowledgeable physician for the ED. Having been a PA in FM for many years, the knowledge in my opinion is invaluable. Of course it is an extra time commitment, and no I am not saying that 3 years of EM is not sufficient. I am just saying that now there is another option instead of choosing the 3 or 4 year EM route. I doubt many of these docs would ever do the FM route after the 5 years but it will make them better EM physicians for certain. For a young person, I think this is an incredible route and I would take it if it were available now, and if I was about 9 years younger.

In a rural setting where you will have a practice of the typical family med stuff AND you work in the ED then without a doubt you would be a rockstar with FM/EM combined!!

however, anywhere else if you trained dually and only worked in the ED after about 5-10 years family medicine won't even look like what it is today.

Recommendations for screenings, HTN meds, htn treatment (not the ER kind), cholesterol meds, diabetes management/medications (as you know) changes LIKE CRAZY FAST.

I still get AAFP's journal and just rotated through last year and I already don't recognize alot of new diabetic/cholesterol/pain/depression meds. that's just after ONE YEAR!

Imagine what it will look like in 10 year etc.....

My point is that you'll be rockstar if you worked on the in the ED for a few years until the breast cancer screening/diabetes/colon cancer/HTN/cholesterol management/depression meds/management etc... changes.

So I don't think it'd help much in the long run.

later

 

[EctopicFetus]

You can already do IM and Peds..with EM thoser arent too hot IIRC

 

[waterski232002]

If you really wanted to do a combined residency and be better/more knowledgeable in the ED, than I think EM/IM would be the better route. It is more important to know/recognize/and be able to manage the serious pathology in the ER (which is more what IM trains for), than for the rash/sniffles/htn/screening that FP better trains for. Not downplaying FP's, but they do not deal with the acuity of IM. Additionally, if you ever wanted to subspecialize, IM would allow you the opportunity.... where as in FP you are severly limited.

I think that's probably why not many people care about the EM/FP combined residency. Also, if you're in a rural setting, you can still practice straight EM if you want to because of the shortage or ER docs. Granted that may change in the next 10-20 years.

 

[docB]

Just out of curiosity what are the ethics and legality of working in an ER AND having a private practice. Can you self refer? When you see your own patients in the ED are you double dipping? Do the insurers balk on bills because they claim you are trying to circumvent outpatient approvals? If you see a competitor's patient and they want to start seeing you as a PMD is that ethically murky? I imagine that the majority of this goes on in rural areas where the fishbowl is even smaller and more visible.

 

[Apollyon]

Just out of curiosity what are the ethics and legality of working in an ER AND having a private practice. Can you self refer? When you see your own patients in the ED are you double dipping? Do the insurers balk on bills because they claim you are trying to circumvent outpatient approvals? If you see a competitor's patient and they want to start seeing you as a PMD is that ethically murky? I imagine that the majority of this goes on in rural areas where the fishbowl is even smaller and more visible.

I would think it similar (although not the same) as the people that are multiply boarded and serve as IM attending (either service or hospitalist) or peds attending (same), or the guy at Columbia who is EM/IM/CC/Pulm, and alternates months between the ED and the MICU. As he said, he admits them end of the month, then is the attending in the unit beginning of the next month.

 

[bulgethetwine]

I would think it similar (although not the same) as the people that are multiply boarded and serve as IM attending (either service or hospitalist) or peds attending (same), or the guy at Columbia who is EM/IM/CC/Pulm, and alternates months between the ED and the MICU. As he said, he admits them end of the month, then is the attending in the unit beginning of the next month.

There is a new combined residency being proposed: EM/IM/PEDS/FM/Surgery/Radiology/OBGYN/PSYCH/Podiatry

It will only take 24 years to complete, at which point you will most probably have the broad knowledge base required to practice independently in a small community ED setting. Thank God! Now, since I couldn't make a decision with regard to what specialty to choose in the first place, I can take them all and have the ultimate knowledge base!

Yea Me!

 

[corpsmanUP]

There is a new combined residency being proposed: EM/IM/PEDS/FM/Surgery/Radiology/OBGYN/PSYCH/Podiatry

It will only take 24 years to complete, at which point you will most probably have the broad knowledge base required to practice independently in a small community ED setting. Thank God! Now, since I couldn't make a decision with regard to what specialty to choose in the first place, I can take them all and have the ultimate knowledge base!

Yea Me!

I seriously wish your roommate would just put a bar of Safeguard in a nice tight cotton sock and whail on you for a few minutes. It might make you less obnoxious and I can guarantee it would make you less arrogant.

 

[monkeyarms]

There is a new combined residency being proposed: EM/IM/PEDS/FM/Surgery/Radiology/OBGYN/PSYCH/Podiatry

It will only take 24 years to complete, at which point you will most probably have the broad knowledge base required to practice independently in a small community ED setting. Thank God! Now, since I couldn't make a decision with regard to what specialty to choose in the first place, I can take them all and have the ultimate knowledge base!

Yea Me!

i'm not sure this residency will really prepare you well enough in neurology. you should probably look to see if you can tack on a fellowship before you try getting a job. if not you're bound to get sued.

 

[peksi]

For those of you training in EM and planing to be ABEM/AOBEM certified, the combined EM/FM residency should give you comfort and security. The crux of this conjoined training is a recognition by ABFM that FM residency alone is NOT sufficient training for EM. This strengthens EM and board certification overall! Trust me this is a key part of the thought process of ABEM.


Paul

 

[EctopicFetus]

Forget Neuro.. You need some ortho work in there.

 

[bulgethetwine]

I seriously wish your roommate would just put a bar of Safeguard in a nice tight cotton sock and whail on you for a few minutes. It might make you less obnoxious and I can guarantee it would make you less arrogant.

Is that you gunner? I had forgotten about you... but welcome back 👎

And for God's sake man, get a spellcheck

 

[Jeff698]

The crux of this conjoined training is a recognition by ABFM that FM residency alone is NOT sufficient training for EM. This strengthens EM and board certification overall! Trust me this is a key part of the thought process of ABEM

That was my take, too. I'm just down the road from JPS in Ft. Worth where they have their "ER fellowship" for FP grads. I wonder what this will do to them. Hmmmmm.....

Take care,
Jeff

 

[sunshine2004]

I am currently a PGY-2 in a EM/FM program. I chose to do the combined program for the flexibility and extra year of experience. If anyone has any questions feel free to reply. 🙂

 

[allendo]

I am currently a PGY-2 in a EM/FM program. I chose to do the combined program for the flexibility and extra year of experience. If anyone has any questions feel free to reply. 🙂

What program are you at?

 

[12R34Y]

I am currently a PGY-2 in a EM/FM program. I chose to do the combined program for the flexibility and extra year of experience. If anyone has any questions feel free to reply. 🙂

You mean extra 2 years of experience. It's a 5 year program.

I assume you are in a DO residency?

 

[DrMom]

You mean extra 2 years of experience. It's a 5 year program.

I assume you are in a DO residency?

All DO EM residencies are 4 years already, so it is only 1 extra year to do the FM.

 

[nuke laloosh]

As above...no more can't get in to ED residency, so match in family and one year fellowship to ED.

 

[sunshine2004]

What program are you at?

I am at SUMMA/CFGH in Ohio. We also have a $20,000 sign on bonus.

 

[allendo]

I am at SUMMA/CFGH in Ohio. We also have a $20,000 sign on bonus.

Is the intern year linked to the residency?

 

[shemozart]

I am at SUMMA/CFGH in Ohio. We also have a $20,000 sign on bonus.

What program is that? You need to give more info - I found the application (!) to become a housestaff member there when i googled it, but not much info other than it's an osteopathic residency.

As an allopathic grad, I would have been all over a combined 5 year residency for FM/EM (I was in favor of a 4 year FM residency when that debate came up as well). There's still FPs to be out there that would love the training - there are tons of rural ERs that it would almost be a shame to have an EM trained group at because they are so low volume (LOW), yet they are critical access hospitals (thus, the FPs who are EM trained could run it on their non-clinic days - like I've seen some hospitals do). I would have been interested in that option....so would have some of the other rural med FP cowboy types. Damn. At least others will have the option.... 😀

 

[allendo]

What program is that? You need to give more info - I found the application (!) to become a housestaff member there when i googled it, but not much info other than it's an osteopathic residency.

As an allopathic grad, I would have been all over a combined 5 year residency for FM/EM (I was in favor of a 4 year FM residency when that debate came up as well). There's still FPs to be out there that would love the training - there are tons of rural ERs that it would almost be a shame to have an EM trained group at because they are so low volume (LOW), yet they are critical access hospitals (thus, the FPs who are EM trained could run it on their non-clinic days - like I've seen some hospitals do). I would have been interested in that option....so would have some of the other rural med FP cowboy types. Damn. At least others will have the option.... 😀

Here it is http://www.summahealth.org/common/templates/contentindex.asp?ID=3132 It's in cayahoga falls, Ohio

 

[corpsmanUP]

Here it is http://www.summahealth.org/common/templates/contentindex.asp?ID=3132 It's in cayahoga falls, Ohio

This illustrates the point I made in one of my previous posts. This website gets a grade of a about a D+ at best. It was likely created in less than 30 minutes by some IT geek who was given a short set of notes from each PD. Why can't DO programs get it in gear and market themselves effectively. Compare this website with ANY allopathic program website on the SAEM website for EM residency programs. Even programs like mine in Iowa that are extremely new have great websites with dozens of pages of information and pictures. You can't sell a car in the Autotrader without a picture, plain and simple!!

 

[ElZorro]

Agree with corpsman's post- osteopathy in general has a ton to learn about marketing. They focus their efforts on the public, when this is in reality not the main problem they have. Their poor QC of their residencies is what will eventually create a huge problem for them.

Jeff- I don't know what will happen with JPS, but I read the other day that they were going to open a new ED in 2007. Also, they have been working toward securing level I status, and already every physician in their ED is BC/BE. So, it is possible they are positioning themselves to have an EM residency or a combined FP/EM track.

 

[allendo]

Agree with corpsman's post- osteopathy in general has a ton to learn about marketing. They focus their efforts on the public, when this is in reality not the main problem they have. Their poor QC of their residencies is what will eventually create a huge problem for them.

Jeff- I don't know what will happen with JPS, but I read the other day that they were going to open a new ED in 2007. Also, they have been working toward securing level I status, and already every physician in their ED is BC/BE. So, it is possible they are positioning themselves to have an EM residency or a combined FP/EM track.

Are you talking about John Peter Smith, in Ft. Worth

 

[Jeff698]

Are you talking about John Peter Smith, in Ft. Worth

Yes

 

[hyperbaric]

Jeff- I don't know what will happen with JPS, but I read the other day that they were going to open a new ED in 2007. Also, they have been working toward securing level I status, and already every physician in their ED is BC/BE. So, it is possible they are positioning themselves to have an EM residency or a combined FP/EM track.

Yes - I kept hearing the rumors, so I asked the director of medical education at JPS when I saw him at a dinner.

 

[pushinepi2]

There is a new combined residency being proposed: EM/IM/PEDS/FM/Surgery/Radiology/OBGYN/PSYCH/Podiatry

It will only take 24 years to complete, at which point you will most probably have the broad knowledge base required to practice independently in a small community ED setting. Thank God! Now, since I couldn't make a decision with regard to what specialty to choose in the first place, I can take them all and have the ultimate knowledge base!

Yea Me!

Most excellent. Could you imagine a typical day at your rural urgent care/EM/FP office ? Perhaps it'd go something like this:

Encounter #1:
DOC: I'm really concerned about this abdominal pain you're having. The differential could include gastroenteritis, aortic dissection, or appendicitis.

PATIENT: Holy crap. Should I go to the ED?

DOC: Probably. I'll meet you there in five minutes.

Encounter #2:
DOC: I'm really concerned about this chest pain you're having. It could be pleuritic, but I cant be sure without a CT scan for pulmonary embolism, serial EKG's, enzymes, and some other blood work.

PATIENT: Holy crap. Should I go to the ED?

DOC: Probably. I'll meet you there in five minutes.

Encounter #3:
DOC: Wow, you're blood pressure is high. Because ACEP doesn't support the treatment of asymptomatic hypertension, I'm not going to prescribe you anything from the ED. However, you should get follow up within the next 2-3 days.

PATIENT: Can you squeeze me in at your office, doc?

DOC: Probably. I'll meet you there in five minutes.

Thank god for categorical EM.

 

[trkd]

Yes - I kept hearing the rumors, so I asked the director of medical education at JPS when I saw him at a dinner.

Yes, what exactly? 😕 Yes, they will be getting an EM residency or yes a combined residency. OR, yes to something completely different. 😕

 

[monkeyarms]

just curious to know if anyone has heard whispers about where these allopathic combined programs may crop up? one of our student deans is a former FM chairman and says the word on the street is that one or two of these may be accepting applicants for this year's match...

 

[EM_Rebuilder]

I've seen surgeons in Tex wearing knee high cowboy boots with their scrubs! Thats a real cowboy who can do surgery all day in boots.

I am an MSIII in Texas and wore my boots almost everyday in surgery...


The best is the female attending that wears the cowboy hat to the OR... she takes it off only if she needs to scrub in to help the residents out.