EM or FP? Please help.

[mamagoose]

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I have been dreading this decision. I am supposed to be applying in the next few weeks but I just don't know what to do. The two options I am considering are small town EM program with little trauma or FP.

The reason I like EM is for the primary care aspect of it but I can also treat those without insurance and the poorer folks around town. I don't mind the urgent care stuff that comes through the emergency dept but I don't really PREFER the emergent stuff (though I can handle it when it does come through). I like the hours and don't mind shift work. Out of my EM rotations, the part I loved most was 2 weeks in hospital in the south with mostly hispanic patients and no trauma.

As for FP, I like the ability to treat my patients without the liklihood of killing them in the short term if I miss something. It seems less stressful and I like the interaction with people (though not all that come through the office). I also like the hours with FP and had a great time on my FP month. I am not really into the OB, colonoscopies, vasectomies, etc.

I suppose I could see my self working in either a poor medium-sized town in an academic FP group or a smaller ED somewhere that doesn't see trauma much.

My friend told me that I should try posting here for some input. I would appreciate anything you guys can give me. Thanks in advance.

 

[Donkey Hote]

As a FP you can certainly work in a small town ER AND have normal FP style clinic, but I'm not so sure you could do it the other way around...ER trained managing chronic disease and providing health maintenance screening...not so sure.

Im kind of the same as you, and think I will probably end up working in a small hospital ER two days a week and having clinic 3 days a week...thats the plan right now, at least...

 

[deleted87716]

You might also consider urgent care. You could do this with training in either EM or FM, although (IMO) FM training will give you more flexibility.

 

[sophiejane]

I think you kind of answered your own question. EM is not supposed to be primary care, but it is. It's supposed to be true emergencies. It sounds like the people you like to see are the ones who should have gone to their FP instead of the ER, but didn't have the funds.

You listed lots of things you like about FP and very few that were specific to EM (in fact, the only one I saw was shift work).

I think you need to ask yourself if you want to be able to follow patients long term. If the answer is yes, I think your answer is FP.

As for treating the underserved, you can do that in FP or EM, but you gotta make a living. If you really just want to serve the poor and only the poor, you should probably do international or domestic relief work, or volunteer in free clinics in your free time.

Best of luck.

 

[mamagoose]

I think you kind of answered your own question. EM is not supposed to be primary care, but it is. It's supposed to be true emergencies. It sounds like the people you like to see are the ones who should have gone to their FP instead of the ER, but didn't have the funds.

You listed lots of things you like about FP and very few that were specific to EM (in fact, the only one I saw was shift work).

I think you need to ask yourself if you want to be able to follow patients long term. If the answer is yes, I think your answer is FP.

As for treating the underserved, you can do that in FP or EM, but you gotta make a living. If you really just want to serve the poor and only the poor, you should probably do international or domestic relief work, or volunteer in free clinics in your free time.

Best of luck.

As for patient follow up, I can do with or without that. I think I am fine either way (which doesn't help the decision any). As for treating the underserved, I would really want to serve predominantly people from lower socioeconomics if possible. International relief work will be in the forefront when I retire but I will stick around here for a while because I want to raise a family here.

As for free clinics, I certainly would like to establish one. I am not sure how feasible it is if I go the EM route but I know it has been done. It would obviously work with the FP route.

To be honest, the thing swaying me toward EM at this moment is the fact that switching to FP after a year will be easier than the other way around, simply based on competitiveness of the respective programs in the match. I figure, I can test it out with EM and switch if I absolutely hate it. Anyone seen this done (this may be a stupid question but I haven't been on the forum very long)?

The other option I thought of is to apply for both rural EM programs and mid-sized FP programs and see what I like most. I don't know of anyone who has done this without preference for one or the other though.

Thank you so much for your help thus far. I really appreciate and look forward to hearing more comments. 😳

 

[iatrosB]

In my experience, EM types are usually hard-wired for trauma. They will deal with the simple primary care type complaints, but salivate over life-threating illness. An FP is more likely to get excited over an acute problem that they can help with that is not life-threating (simple lacs and such). It really sounds like your long term goals and interest are very alligned with FM (I'm not just saying that because this is the FM forum, I bet the EM guys would tell you the same). FM will train you well for the things you want to do. I personally, would hate the thought of switching training programs, I would try to decide now (easier said then done, I know). But in all likelihood, it seems as if you'd be happier in FM (of course I don't really know you or what you want out of life/practice, but that is my observation from your comments).

 

[slim shanie]

I was in the same boat as you up until a few months ago and I ultimately decided on FP then a sports med fellowship. The thing I like the most about FP is that you can dictate what you want to do and what you want to see. If you don't want to do OB you don't have to. If you're a big procedure person, you can do that.

My personal FP works as a first surgical assist once a week because he liked surgery but also liked long-term care. I'm externing in an ED where an FP works a 24 hour shift once a week as well as his FP clinic 3-4 days a week.

The flexibility of FP is really its strong suit. If you're still not deciding after wrestling with this, I would suggest applying to both with different personal statements (or even the same, if you can swing it) and interviewing at those places. You're not alone in feeling this way, I can assure you. Is there anyone at your school you could talk to more specifically about this?

I have to agree with the others that from the language you're using it sounds like FP is what you want to do... but treating the underserved isn't feasible if you do that. That's the only thing that's keeping EM in your mind. Like someone said, you have to make a living though and having 50% patients underserved isn't feasible unless you tinker with your schedule or do that kind of work on the side (urgent care, international work).

 

[Tn Family MD]

Maybe you should look into an FM program that has an EM fellowship associated with it. Our program here at UT-Knoxville is an excellent example. There is no EM residency here, so our fellows get priority in working the ER. Also our center is a regional trauma center and the fellows rotate with the trauma team, gaining valuable experience for those instances where emergent trauma victims WILL roll through your ER no matter how small. Something to think about, I guess.

 

[sophiejane]

In my experience, EM types are usually hard-wired for trauma. They will deal with the simple primary care type complaints, but salivate over life-threating illness.

I agree. It seems a little odd for someone who likes primary care and doesn't like trauma to choose EM for a career, but that's just my view from the outside, not knowing much about you.

 

[mamagoose]

An FP is more likely to get excited over an acute problem that they can help with that is not life-threating (simple lacs and such).

This describes me quite well. I just feel a bit trapped all together. I have a really good setup in EM with the EM standard letters of rec (the letter EM folks use for EM-bound students) and good connections. I am a bit hesitant to change it all now but this feeling of indecision is really worrisome. I just really feel unhappy with the thought of either because neither sounds "perfect" for me like it seems for everyone else. I just want something to "fit" me.

Thanks for all the thoughts and supportive comments. I really appreciate it.

 

[sophiejane]

I just really feel unhappy with the thought of either because neither sounds "perfect" for me like it seems for everyone else. I just want something to "fit" me.

I totally understand this. I think many people have to bend a bit to fit into one field or the other. I love OB, but don't want to do it all the time, and I know that it will be a challenge to do OB as an FP, but I had to make that compromise.

You will find what you are willing to compromise and what you aren't...

 

[iatrosB]

This describes me quite well. I just feel a bit trapped all together. I have a really good setup in EM with the EM standard letters of rec (the letter EM folks use for EM-bound students) and good connections. I am a bit hesitant to change it all now but this feeling of indecision is really worrisome. I just really feel unhappy with the thought of either because neither sounds "perfect" for me like it seems for everyone else. I just want something to "fit" me.

Thanks for all the thoughts and supportive comments. I really appreciate it.

Well, I don't know how you feel about training length, but there are EM/FM and EM/IM combined programs out there. Maybe try something like that? Good luck.

 

[mamagoose]

Well, I don't know how you feel about training length, but there are EM/FM and EM/IM combined programs out there. Maybe try something like that? Good luck.

There is only one MD EM/FM program I know of. I will definitely be applying. I wish there were more. I would put in the years.

Here is another idea, how much credit do you get for having done another residency and coming into FP. I know if you switch into EM you get 6 months max. What about switching in FP. If I could get a year credit, for example, then I could do both in 5 years (same as the combined program). Anyone know the answer to that? I know it is not ideal but training length does not concern me.

 

[sophiejane]

There is only one MD EM/FM program I know of. I will definitely be applying. I wish there were more. I would put in the years.

Here is another idea, how much credit do you get for having done another residency and coming into FP. I know if you switch into EM you get 6 months max. What about switching in FP. If I could get a year credit, for example, then I could do both in 5 years (same as the combined program). Anyone know the answer to that? I know it is not ideal but training length does not concern me.

I can't imagine you'd get any more credit in FP than you'd get in any other program. The curricula are different. I would think you'd only get credit for what overlaps.