EM/FM transition

[scoopdaboop]

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So why can FM/IM trained docs go to EM, but not the other way around? I understand there might be some legal barrier to it right now, or that a group might not hire a guy boarded in just EM, but could you be FM board certified as an ER-residency trained doc, and do FM also? I am curious because it might turn into a nice career transition later in an ER doc's career where he is tired of the hectic shifts in the ER.

Thanks

 

[watermanMD]

I think there needs to be a pathway. This would be good on so many levels. So much of EM is primary care already. Toss some weekend trainings in there to refresh some chronic care stuff and voila--aiding the PCP workforce (I realize it's not quite that simple)

 

[gamerEMdoc]

#1. EM/IM docs who want to work in the ED aren't board certified. The reason they are being hired is because they can't find an board certified doc to work in the ED at the price point they want to pay
#2. That implies FP/IM are willing to work for less money than an EM doc to work a sleepy job
#3. So if an EM doc wanted to work in a FP clinic, as a non-FP doc, they would have to basically accept getting paid lower than the market rate than an FP boarded physician. Think PA/NP money.
#4. Oh yeah, CRNPs are everywhere now and flooding the FP market. So they don't need non-boarded FP docs to work for nothing in some FP clinic. They already have people who will do that.
#5. If you really wanted to do this, you could. You don't need to be board certified in ANYTHING to do it, you'd just have to meet their credentialing guidelines. You just can't advertise yourself as a board certified physician in that field.

 

[betamale]

Probably the prev med pathway.

Do CMEs in prev med, chronic disease mgmt, primary care psych, peds, OBGYN, geriatric s through CMEs
Work 2 yrs in a prev med clinic.

https://www.theabpm.org/become-certified/specialties/public-health-general-preventive-medicine/

 

[RustedFox]

There's a bunch of "old" EM folk that hung a shingle and opened a clinic around these parts.

I wouldn't go to any of them. They're not good at outpatient FM, and from what I can gather from the elder nursing staff around these parts... they weren't very good at EM when they were EM.

 

[gamerEMdoc]

There are plenty of jobs for EM docs if they want to slow down. That will make them more money than working in an FP clinic. Urgent care. Working in a SLOOOOOOW ED. There are rural EDs where you can get paid to sleep and sometimes not see a single patient. You won't make 300/hr, but you'll make more money than working 5 days a week in an FP clinic.

 

[RustedFox]

Seriously. There's a list of 4-5 guys around the area that "quit EM" and now do outpatient stuff, 9-5.

Whenever I see one of their patients in the ER, I want to scream.

 

[gamerEMdoc]

There's a bunch of "old" EM folk that hung a shingle and opened a clinic around these parts.

I wouldn't go to any of them. They're not good at outpatient FM, and from what I can gather from the elder nursing staff around these parts... they weren't very good at EM when they were EM.

It's as if doing a residency in something and getting boarded actually trains you to do that field. No matter how much overlap there may seem to be, they aren't the same.

 

[RustedFox]

It's as if doing a residency in something and getting boarded actually trains you to do that field. No matter how much overlap there may seem to be, they aren't the same.

Imagine that !

Now, if medicare/medicaid simply paid the FM folk what they are actually work... they'd probably work.... More.... and work.... longer.... and make the money!

 

[RustedFox]

Imagine that !

Now, if medicare/medicaid simply paid the FM folk what they are actually work... they'd probably work.... More.... and work.... longer.... and make the money!

Also coming soon: RustedFox Rants: "Why today's old people suck, and have basically done nothing to earn respect and their "share" in the Medicare system."

Teaser: "These old people can't tell you why Trotsky was assassinated , but they can tell you that Peter Fonda was in a movie with an American Flag on his leather jacket, and it was iconic (it wasn't; I watched it - it was a bad movie.)" They also can't tell you who else was in that movie, in general. Nevermind that they were more compelling characters.

 

[Hercules]

So why can FM/IM trained docs go to EM, but not the other way around? I understand there might be some legal barrier to it right now, or that a group might not hire a guy boarded in just EM, but could you be FM board certified as an ER-residency trained doc, and do FM also? I am curious because it might turn into a nice career transition later in an ER doc's career where he is tired of the hectic shifts in the ER.

Thanks

I think several people have answered already but the simplest response is why in the world would you want to go from EM to being a PCP? You weren’t trained for it, you very well may not like it, and you’ll take a significant pay cut. If you just want lower acuity and no nights then work in slow EDs (accepting only day shifts).

Better yet, make good financial decisions and become FI so you don’t have to worry about the pay.

 

[alpinism]

So why can FM/IM trained docs go to EM, but not the other way around? I understand there might be some legal barrier to it right now, or that a group might not hire a guy boarded in just EM, but could you be FM board certified as an ER-residency trained doc, and do FM also? I am curious because it might turn into a nice career transition later in an ER doc's career where he is tired of the hectic shifts in the ER.

Thanks

Why not just work in a rural ER that only sees 5K pts a year? Thats under 1 PPH with plenty of down time to relax and take breaks during a shift.

 

[VA Hopeful Dr]

I think several people have answered already but the simplest response is why in the world would you want to go from EM to being a PCP? You weren’t trained for it, you very well may not like it, and you’ll take a significant pay cut. If you just want lower acuity and no nights then work in slow EDs (accepting only day shifts).

Better yet, make good financial decisions and become FI so you don’t have to worry about the pay.

Or urgent care, it's like doing primary care without the chronic disease management

 

[Sterling_Archer]

Why?

Seriously. There's a list of 4-5 guys around the area that "quit EM" and now do outpatient stuff, 9-5.

Whenever I see one of their patients in the ER, I want to scream.

 

[RustedFox]

Why?

Why did they quit EM ? Or why do I want to scream when I see one of their patients in the ER?

 

[Sterling_Archer]

Why do you want to scream?

Why did they quit EM ? Or why do I want to scream when I see one of their patients in the ER?

 

[RustedFox]

Why do you want to scream?

Because these patients are generally very demanding, and the doc is generally unavailable to them.

 

[Hamhock]

An EM doc in the clinic (except for urgent care) would be dangerous.

How may BCEM docs here can remember the tumor markers/oncology work up? Anyone able to name three birth control pills and when #3 is better than #1? How about the evaluation of hypercalciuria?

Note, this stuff isn't easily looked up, even in a clinic with a "slower" pace.

Just as an FM doc is dangerous in an ED (especially single-coverage), EM docs are dangerous in the primary care clinic.

HH

 

[GonnaBeADoc2222]

I keep failing to understand these repeated questions of can x field switch to y.

No IM cannot do EM
FM cannot do EM (well)
Surgery cannot do EM
EM cannot do any of the above
Radiology cannot do anesthesiology
Pathology cannot do Pediatrics
Neurosurgery cannot to dermatology

Train for the job you want. Why is this so difficult to understand?

 

[watermanMD]

What if the job you want changes?

 

[TooMuchResearch]

Then do some medicine off shoot, but don't practice a specialty you don't know.

What if the job you want changes?

 

[emergentmd]

An EM doc in the clinic (except for urgent care) would be dangerous.

How may BCEM docs here can remember the tumor markers/oncology work up? Anyone able to name three birth control pills and when #3 is better than #1? How about the evaluation of hypercalciuria?

Note, this stuff isn't easily looked up, even in a clinic with a "slower" pace.

Just as an FM doc is dangerous in an ED (especially single-coverage), EM docs are dangerous in the primary care clinic.

HH

I would just hang a shingle, take care of UC stuff, and everything else consult? My specialist would love me.

Tumor marker workup - send to my oncologist
Hypercalciuria - Is that Nephro?
Anything urgent - Go to ER.

What am I missing????

 

[emergentmd]

I keep failing to understand these repeated questions of can x field switch to y.

No IM cannot do EM
FM cannot do EM (well)
Surgery cannot do EM
EM cannot do any of the above
Radiology cannot do anesthesiology
Pathology cannot do Pediatrics
Neurosurgery cannot to dermatology

Train for the job you want. Why is this so difficult to understand?

I dont think there is a discussion of if they can do it well. We all know that 99% of the unboarded docs are worse than boarded. Anything who thinks otherwise is delusional or should stop repeating a unicorn story. Yeah, the one where an FM trained doc in a single facility took care of a mass shooting, did 3 thoracotomy, 10 central lines, 6 intubations, 3 burr holes in under an hr and all of them are working in high functional fields.

What they are asking for is, I went into this crappy low paying field. Can I fly under the radar and do a decent job calling myself a trained specialist so I can make 2 times the money?

If FM made EM money, I bet many EM docs would be doing FM. Hell, I know EM docs who went to do Derm stuff to make money.

Just follow the money. It has nothing to do with care, skills, capacity, legality. If FM made 400K/yr, do you really think any would want to go into EM?

 

[GonnaBeADoc2222]

I think there needs to be a pathway. This would be good on so many levels. So much of EM is primary care already. Toss some weekend trainings in there to refresh some chronic care stuff and voila--aiding the PCP workforce (I realize it's not quite that simple)

This is an insult to good primary care physicians.

 

[Old_Mil]

Do urgent care. Though we could probably successfully make many of the the same necessary diagnoses required of the primary care physician, we aren't trained in long term management of them.

 

[deuist]

I don't see this pathway mentioned on the link you supplied. At a minimum, one year of GME is going to be required.

Probably the prev med pathway.

Do CMEs in prev med, chronic disease mgmt, primary care psych, peds, OBGYN, geriatric s through CMEs
Work 2 yrs in a prev med clinic.

https://www.theabpm.org/become-certified/specialties/public-health-general-preventive-medicine/

 

[Vandalia]

I would just hang a shingle, take care of UC stuff, and everything else consult? My specialist would love me.

Tumor marker workup - send to my oncologist
Hypercalciuria - Is that Nephro?
Anything urgent - Go to ER.

What am I missing????

What you are missing is when the nurse practitioner who sees those "consults" sends you back the patient. To quote from a NP seen "consult" I saw in the EMR by one of the local GI groups last year.

"It appears the patient does have Chrohn's Disease. Stelara has been helpful in the treatment of Crohn's Disease. If you have any questions please don't hesitate to contact us, but we will not be accepting management of this patient."

In the "good old days" there was a quid pro quo: the primary care doc had the lucrative patients for a scope, and in return for the referral the specialist agreed to accept management of the chronic patients. Now, with "health system" affiliated groups, those specialists are expected (and want) to do procedures all the time, so all the patients they used to manage are now dumped back to the primary care docs.

 

[GonnaBeADoc2222]

What you are missing is when the nurse practitioner who sees those "consults" sends you back the patient. To quote from a NP seen "consult" I saw in the EMR by one of the local GI groups last year.

"It appears the patient does have Chrohn's Disease. Stelara has been helpful in the treatment of Crohn's Disease. If you have any questions please don't hesitate to contact us, but we will not be accepting management of this patient."

In the "good old days" there was a quid pro quo: the primary care doc had the lucrative patients for a scope, and in return for the referral the specialist agreed to accept management of the chronic patients. Now, with "health system" affiliated groups, those specialists are expected (and want) to do procedures all the time, so all the patients they used to manage are now dumped back to the primary care docs.

That seems sort of....****ty.

 

[VA Hopeful Dr]

That seems sort of....****ty.

I have never seen anything like that before because the instant I did that specialist would never get another patient from me as long as I live. And the specialists know that and so don't pull that kind of crap.

 

[thegenius]

I keep failing to understand these repeated questions of can x field switch to y.

No IM cannot do EM
FM cannot do EM (well)
Surgery cannot do EM
EM cannot do any of the above
Radiology cannot do anesthesiology
Pathology cannot do Pediatrics
Neurosurgery cannot to dermatology

Train for the job you want. Why is this so difficult to understand?

Neurosurgery can do ANYTHING IT WANTS.

 

[thegenius]

I would just hang a shingle, take care of UC stuff, and everything else consult? My specialist would love me.

Tumor marker workup - send to my oncologist
Hypercalciuria - Is that Nephro?
Anything urgent - Go to ER.

What am I missing????

Nothing. That's today's primary care protocols.
Sad really. Just another problem with our health care system. The proliferation of specialty care.

 

[watermanMD]

This is an insult to good primary care physicians.

You rite. Maybe a year—fellowship-type deal? You think EM could manage pt’s at least as well as the APP’s that don’t require oversight? Aren’t they seeing pt’s for primary care day one out of their post-grad training?