EM/FM What do you think about this?

[han14tra]

."Combined training is a clear advantage for students who are contemplating a career in family medicine in rural areas where they also may be the sole provider of emergency care services." I don't really understand this. Could you explain what you think it means?
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[Sharn Penndroen]

It's basically making the arguement that if you are planning on being the only doc in town somewhere you will be the only guy providing emergency medicine care. You should be more comfortable and knowledgable in dealing with trauma in that town if you have combined training in Emergency Medicine.

Some people would make the arguement that you could just do EM and have a rural primary care practice, but in reality EM doesn't really train you for that. Just like FM doesn't really train you as well as EM for trauma.

It's a matter of what you want to make of your career and if it is worth the extra years of training to you to get double boarded.

 

[MaxDesMer]

I interviewed at this program. Simply, it says that you will be highly qualified to care for anyone, both acutely and chronically. It is great for working in small town america, especially in under served areas, or internationally, where you might need to intubate someone or place a chest tube or care for someone with HIV related diseases chronically.

 

[NewmansOwn]

."Combined training is a clear advantage for students who are contemplating a career in family medicine in rural areas where they also may be the sole provider of emergency care services." I don't really understand this. Could you explain what you think it means?.

Agree with the above. I was just skiing out in Jackson Hole, WY and the clinic there is run by a guy who's double cert in EM and FM. If it matters to you, he cleans up financially. But more importantly, I think, he gets the satisfaction of being the "country doc" for a whole lot of people (gets way more respect than an urban PCP would get) AND he provides life-saving emergency services for stupid/arrogant/hardcore skiers. Also, if he feels like taking an extra vacation and needs some extra cash, he can just moonlight in the ER for a night shift and get a nice hefty lump sum.

 

[nymbarra]

FP/EM sounds like a good option.

But...

1) There used to be EM fellowships for FP residents. I think the last one closed a few years ago in Tennessee. It makes me wonder why Christiana decided to start one. Then again, there used to be other EM/IM programs that closed (eg, Northwestern), and while some EM/IM's are old, most started in the '90s.

2) EM/IM is a good alternative. You get the option to do subspecialty fellowships afterwards (if you can handle extending your training after 5 years!), and there is a good track record for going into academics. CC is a popular option, too, which many places are trying to implement. I also think that IM training is culturally different from FP.

3) Another alternative are the bad a** FP programs out there. You know, unopposed residencies with lots of surgical experience, eg Martinez and Ventura. If you want to be the rural doc who can handle anything, I think these are the places to look at.

4) Then again, you can't beat moonlighting to pay for a trip...although it seems that the more rural you get, the less likelihood that you need to be BC/BE in EM to work in the ED.

 

[R0x0r Mc0wnage]

what is the length of the EM/FM dual residency?

 

[Brob459]

what is the length of the EM/FM dual residency?

most are 5 years.....

 

[193250]

Could you practice both EM and then IM while not on shift? If so, how would the schedule be like?

 

[megawhizz]

Could you practice both EM and then IM while not on shift? If so, how would the schedule be like?

I split my time between EM and IM, 75% time working in an academic ED and 25% time as supervising staff on the inpatient general medicine rounding team. I never do both together, i.e. when I am on a 2-week block of IM rounding I am off the ED schedule.

My colleagues have made similar arrangements, really you have to negotiate with the two departments to figure out exactly what you can do, it's usually done on a case-by-case basis.

 

[MaxDesMer]

FP/EM sounds like a good option.

But...

1) There used to be EM fellowships for FP residents. I think the last one closed a few years ago in Tennessee. It makes me wonder why Christiana decided to start one. Then again, there used to be other EM/IM programs that closed (eg, Northwestern), and while some EM/IM's are old, most started in the '90s.

2) EM/IM is a good alternative. You get the option to do subspecialty fellowships afterwards (if you can handle extending your training after 5 years!), and there is a good track record for going into academics. CC is a popular option, too, which many places are trying to implement. I also think that IM training is culturally different from FP.

3) Another alternative are the bad a** FP programs out there. You know, unopposed residencies with lots of surgical experience, eg Martinez and Ventura. If you want to be the rural doc who can handle anything, I think these are the places to look at.

4) Then again, you can't beat moonlighting to pay for a trip...although it seems that the more rural you get, the less likelihood that you need to be BC/BE in EM to work in the ED.

1) I interviewed at Christiana last year. Great PD there. Super enthusiastic and approachable. She is working to create some innovate systems solutions through new delivery models that will keep people out of the ED that don't need to be there without violating EMTALA. if this is something you are interested in, you will be in very very good hands. The EM program has a fantastic reputation as well.

2) The EM/IM/CC tract is something that places have been taking about for sometime, but few have been able to pull the trigger. U Pitt has had one approved for nearly 2 years now and still not made it official.

3) no comment
4) The concept that you don't need to be BC/BE in EM in rural areas will not be the case in the next 5-10 years. EM residencies are growing rapidly. Urgent Care might be more of an option that an actual ED if you are not BE/BC in EM.

 

[bvmajik]

Could you guys name some of these em/fp programs? I've looked around the site and google but couldn't come up with anything concrete such as a listing on aafp or the likes.

 

[Drawing Dead]

Could you guys name some of these em/fp programs? I've looked around the site and google but couldn't come up with anything concrete such as a listing on aafp or the likes.

The only ACGME EM/FP program is Christiana in Delaware.

There are 4 Osteopathic programs, St. Barnabas in BX, NY, Frankford Hospital in Philadelphia, PA, Pontiac Hosptial, in suburban Detroit, and St. James Hospital in the Chicago Suburbs. St. James suspended it's recruitment this year, and it's unclear if they will recruit for the 2009-10 applicant pool. There was a 5th in Ohio, but last I heard they closed.

If you are searching for ANY PROGRAMS, ACGME or AOA, you can check out the FREIDA link on the AMA's website, and the opportunities link on the AOA's website. PM me if you have any other questions.

 

[JackBauERfan]

The only ACGME EM/FP program is Christiana in Delaware.

There are 4 Osteopathic programs, St. Barnabas in BX, NY, Frankford Hospital in Philadelphia, PA, Pontiac Hosptial, in suburban Detroit, and St. James Hospital in the Chicago Suburbs. St. James suspended it's recruitment this year, and it's unclear if they will recruit for the 2009-10 applicant pool. There was a 5th in Ohio, but last I heard they closed.

If you are searching for ANY PROGRAMS, ACGME or AOA, you can check out the FREIDA link on the AMA's website, and the opportunities link on the AOA's website. PM me if you have any other questions.

Also, freida is listing LSU shreveport as having a combined program

 

[Perrotfish]

The only ACGME EM/FP program is Christiana in Delaware.

They just started one this year in Louisiana. Can't remember the hospital.

I think the reasoning here is that the EM demand is high enough in a lot of underserved areas that more and more FPs are working in the ER part time. I knew an FP who spend his weekends in the ER until he paid down his debt (I'm guessing that was the reason, he definitely didn't keep it up The problem is that, well, FPs aren't really trained to do that. The goal here is to give FMs a fast way to get at least somewhat qualified for the moonlighting they're already doing.

 

[Drawing Dead]

They just started one this year in Louisiana. Can't remember the hospital.

I think the reasoning here is that the EM demand is high enough in a lot of underserved areas that more and more FPs are working in the ER part time. I knew an FP who spend his weekends in the ER until he paid down his debt (I'm guessing that was the reason, he definitely didn't keep it up The problem is that, well, FPs aren't really trained to do that. The goal here is to give FMs a fast way to get at least somewhat qualified for the moonlighting they're already doing.

I guess you mean the above mentioned Shreveport program. Must be new, since I don't remember seeing it last year.

I don't know about fast, since our programs are 5 years, vs a 3 year FM program. If you go to 7 programs, you will get 7 answers as to what their philosophy is. Many of them will tell you it is some version of being the ideal rural physician, who can handle primary care as well as emergencies, whether it is adult, peds, or obstetrics.

 

[AgDoc84]

In looking at the limited info there is on the AOA accredited FM/EM programs it seems like the EM component is often, for lack of a better description, watered down... i.e. all are at Trauma II facilities which isnt that huge of an issue, but... and it just seems like the EM components are less stringent. Do we know how the real world looks on these programs, and if you are REALLY trained to work in a high volume, high acuity setting?

 

[Drawing Dead]

In looking at the limited info there is on the AOA accredited FM/EM programs it seems like the EM component is often, for lack of a better description, watered down... i.e. all are at Trauma II facilities which isnt that huge of an issue, but... and it just seems like the EM components are less stringent. Do we know how the real world looks on these programs, and if you are REALLY trained to work in a high volume, high acuity setting?

The last two graduates from my program are working primarily as EM attendings. Most of us went into these programs basically with the mindset that it was EM first, and FM as a back up.

The EM components are reduced, I think we do something like 6 less months of EM than my colleagues in the straight EM program. I will agree with that. On the other hand, we get additional training in specialty fields (like ID, Derm, GI, etc) that the EM program does not get. Not everyone may agree, but I feel as if the FM component of my program will make me more rounded and able to give more definitive care in the ED.

The mission, at least at my program, of the combined program is to train rural physicians. Doctors that can handle every day primary care, but also able to give care when the crap hits the fan. Do I think I'll be able to work in a trauma center when I graduate? Sure. Why? Because trauma is so algorithmic that a 2 day course certifies you to handle trauma. (Just like taking ACLS prepares you to run a code, but you have to take it for what it's worth).

Applicants to EM/FM have to decide what they want to do with it before hand. If you are really concerned with the lack of training on the EM side of it, then maybe you should just be doing EM. But I can tell you pretty much right now, that most graduates do EM primarily. We actually do have a study ongoing right now though, to follow up with graduates from the programs, to see what they are doing with their training.

 

[7starmantis]

Naive question:
After a combined residency like this one can you go on to a fellowship say in toxicology or something?

 

[dragonfly99]

If it's an ACGME approved ER residency, even a combined one, I'm pretty sure you could do a toxicology fellowship. But IMHO if you really want to do a fellowship then you might want to pick a residency that isn't 5 years to start off with, unless you just love being an academic and are sure you won't burn out.

 

[7starmantis]

If it's an ACGME approved ER residency, even a combined one, I'm pretty sure you could do a toxicology fellowship. But IMHO if you really want to do a fellowship then you might want to pick a residency that isn't 5 years to start off with, unless you just love being an academic and are sure you won't burn out.

Yeah, thought about that, just trying to cover my bases. Got a little while before I have to make decisions

 

[Powdermonkey]

The last two graduates from my program are working primarily as EM attendings. Most of us went into these programs basically with the mindset that it was EM first, and FM as a back up.

The EM components are reduced, I think we do something like 6 less months of EM than my colleagues in the straight EM program. I will agree with that. On the other hand, we get additional training in specialty fields (like ID, Derm, GI, etc) that the EM program does not get. Not everyone may agree, but I feel as if the FM component of my program will make me more rounded and able to give more definitive care in the ED.

The mission, at least at my program, of the combined program is to train rural physicians. Doctors that can handle every day primary care, but also able to give care when the crap hits the fan. Do I think I'll be able to work in a trauma center when I graduate? Sure. Why? Because trauma is so algorithmic that a 2 day course certifies you to handle trauma. (Just like taking ACLS prepares you to run a code, but you have to take it for what it's worth).

Applicants to EM/FM have to decide what they want to do with it before hand. If you are really concerned with the lack of training on the EM side of it, then maybe you should just be doing EM. But I can tell you pretty much right now, that most graduates do EM primarily. We actually do have a study ongoing right now though, to follow up with graduates from the programs, to see what they are doing with their training.

Here's my question:

If I do an FP residency and then do an ER fellowship (There are 4 or 5 available last I checked, and yes, UT still has one, I talked to their residents yesterday at a hospital day we had at school) will I be prepared for the ER side of things? All of my profs and the people I've had a chance to talk to seem to think I would be because they all say that EM is just FP on steroids. Which, I guess it is, but at the same time, there is a lot of trauma and other aspects of it that just aren't addressed in FP.

I really want to do EM, but I like the idea of being able to open up a clinic eventually if I ever get tired of it or just want a change, or whatever. But to be board certified I'll have to do an EM/FP dual program which is an extra year... so.... Thats where I am stuck. Any thoughts?

 

[LadyWolverine]

All of my profs and the people I've had a chance to talk to seem to think I would be because they all say that EM is just FP on steroids. Which, I guess it is, but at the same time, there is a lot of trauma and other aspects of it that just aren't addressed in FP.

???

While there are definitely some overlaps in scope of practice, and both see a wide variety of patients and complaints, I don't understand this statement. As a matter of fact, I don't think you can get more different than FP and EM. EM treats the emergent life/limb threatening complaint, and then focuses on finding follow-up for the non-emergent. The role of the FP is to be that follow-up, as well as to provide longitudinal care and coordination. One is acute, the other chronic. I know that's not really the way it works today, but, in theory, that's how it should go.

 

[BronzD]

Is there any chance that an FP/EM residency will be incorporated into the National Health Service Corps "primary care" standards? It seems that FP/EM training would be quite useful in alot of the situations NHSC Scholars face.
-Hopeful Premed

 

[howelljolly]

Here's my question:

If I do an FP residency and then do an ER fellowship (There are 4 or 5 available last I checked, and yes, UT still has one, I talked to their residents yesterday at a hospital day we had at school) will I be prepared for the ER side of things? All of my profs and the people I've had a chance to talk to seem to think I would be because they all say that EM is just FP on steroids. Which, I guess it is, but at the same time, there is a lot of trauma and other aspects of it that just aren't addressed in FP.

I really want to do EM, but I like the idea of being able to open up a clinic eventually if I ever get tired of it or just want a change, or whatever. But to be board certified I'll have to do an EM/FP dual program which is an extra year... so.... Thats where I am stuck. Any thoughts?

I heard that the last of the EM fellowships for FP docs closed down in '09.

 

[WildcatsDoc]

I heard that the last of the EM fellowships for FP docs closed down in '09.

I think this one is still up:

http://gsm.utmck.edu/family_medicine/emergencymed.cfm

There was one at in West TN near Jackson, but I think it did shut down.