EM/Peds combined vs EM-Peds fellowship

[Colbert]

Admittedly, as an MS-1, I may be getting a bit ahead of myself, but I'm more looking for information than deciding what I'm doing with my career.

I understand the level of competitiveness for landing residencies, but I'm pretty naive as to how certain residencies can influence your later employment. Say, for instance, my dream is to work in the ER at a pediatric hospital. What would make me more competitive to land that job, a combined EM/Peds residency, or a EM residency followed by a Peds fellowship (or Peds followed by EM fellowship, if that's even available)?

What is the difference in terms of experience and level of training through these two options? Is one favored by future employers than the other?

Thanks in advance!

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[Apollyon]

Peds --> Peds EM fellowship.
EM --> Peds EM fellowship.

That's the only way to get Peds EM board certified (it's a subspecialty).

EM fellowships are NOT, essentially, a viable track (even if they exist by that time, not a feather in your cap). Moreover, even if there were, I believe you'd need an adult primary care residency (FM or IM) to qualify.

It's an age-old political thing, but doing EM/Peds will NOT make you Peds EM board eligible.

Search on the forum. LOTS more about it.

 

[Powder]

As above if you want to be board certified in Peds EM you should not do a combined program. If you only want to do Peds and never see an adult then peds residency followed by peds ED fellowship will work. Peds residency followed by peds ED fellowship is more competative than peds ED fellowship coming from ED residency and Peds ED fellowship is 3 years for peds and only 2 from ED residency. I did an ED residency then applied to Peds ED fellowship. Any questions feel free to pm me.

 

[SoCuteMD]

Admittedly, as an MS-1, I may be getting a bit ahead of myself, but I'm more looking for information than deciding what I'm doing with my career.

I understand the level of competitiveness for landing residencies, but I'm pretty naive as to how certain residencies can influence your later employment. Say, for instance, my dream is to work in the ER at a pediatric hospital. What would make me more competitive to land that job, a combined EM/Peds residency, or a EM residency followed by a Peds fellowship (or Peds followed by EM fellowship, if that's even available)?

What is the difference in terms of experience and level of training through these two options? Is one favored by future employers than the other?

Thanks in advance!

Most children's hospitals are academic centers, and tend to staff their EDs with board certified Pedi EM folks who did a full peds residency followed by an EM fellowship. The director of the pedi ED at our children's hospitals told me that this applies especially in the Northeast (our hospital will not hire EM--> pedi EM trained folks), although it's an opinion I've heard from those in administration at children's hospitals in other parts of the country as well.

 

[el_chavo]

As above if you want to be board certified in Peds EM you should not do a combined program. If you only want to do Peds and never see an adult then peds residency followed by peds ED fellowship will work. Peds residency followed by peds ED fellowship is more competative than peds ED fellowship coming from ED residency and Peds ED fellowship is 3 years for peds and only 2 from ED residency. I did an ED residency then applied to Peds ED fellowship. Any questions feel free to pm me.

hey Powder,
I'm a ms3 and EM is a frontrunner right now. I think I could advocate more for kids and would enjoy having a significant part of my patient population be pediatric. However, I don't want to leave behind all of adult medicine. Part of what attracts me to EM is the variety, so I feel like I would still like to treat people from across the age spectrum with a pediatric lean.
So my question is: After doing an EM residency with peds ED fellowship could I or would I still be able to work in an adult ED? I am interested in academics so a fellowship makes sense for me as well. Also, Did you apply to all peds ED fellowships including those that are listed as peds to peds ED on frieda?
thanks

 

[Powder]

Yes you can work with adults, that is a major benefit of doing a EM residency. This makes you very marketable when you finish. Also you can moonlight in any adult ED during fellowship to earn extra money. I applied to both em and peds programs listed on frieda. many of the programs listed as peds take em residents and have 2 fellowships. Peds is a 3 year fellowship

 

[bulgethetwine]

Most children's hospitals are academic centers, and tend to staff their EDs with board certified Pedi EM folks who did a full peds residency followed by an EM fellowship. The director of the pedi ED at our children's hospitals told me that this applies especially in the Northeast (our hospital will not hire EM--> pedi EM trained folks), although it's an opinion I've heard from those in administration at children's hospitals in other parts of the country as well.

The problem? Those fellowships have about 50 spots for 500 applicants. Not great odds if you KNOW from day one that you want to do EM.

Just to keep things in historical perspective for when someone does a search someday (the details have been posted in another thread) the above post is *NOT* a consensus opinion in terms of peds ED employers not hiring EM --> pedi EM trained folks.

SoCute knows a lot, is a mod on this forum, and I have no interest in taking a personal shot at someone who clearly is very informed, conscientious, and will be a great physician someday. But he/she is being let down by provinical opinions at his/her institution. See other posts from other attendings when you search the forums.

 

[FoughtFyr]

Most children's hospitals are academic centers, and tend to staff their EDs with board certified Pedi EM folks who did a full peds residency followed by an EM fellowship. The director of the pedi ED at our children's hospitals told me that this applies especially in the Northeast (our hospital will not hire EM--> pedi EM trained folks), although it's an opinion I've heard from those in administration at children's hospitals in other parts of the country as well.

The problem? Those fellowships have about 50 spots for 500 applicants. Not great odds if you KNOW from day one that you want to do EM.

SoCute,

Just so you are aware, this may be an artifical bias. There are very few EM folks who go on for a peds EM fellowship. It boils down to an extra two years that essentially only reduces your pay. What does seem to happen more commonly (perhaps because of the combined programs) is true general peds and general EM residencies done by the same person. These folks cannot currently be boarded in peds EM and are generally not as hirable by academic institutions.

In truth, there are so few EM -> Peds EM folks out there that it would be nearly impossible to be biased against them as a class. It would be like someone stating that an institution wouldn't hire albinos. True, none may be on staff, but how many applied?

- H

 

[SoCuteMD]

SoCute,

Just so you are aware, this may be an artifical bias. There are very few EM folks who go on for a peds EM fellowship. It boils down to an extra two years that essentially only reduces your pay. What does seem to happen more commonly (perhaps because of the combined programs) is true general peds and general EM residencies done by the same person. These folks cannot currently be boarded in peds EM and are generally not as hirable by academic institutions.

In truth, there are so few EM -> Peds EM folks out there that it would be nearly impossible to be biased against them as a class. It would be like someone stating that an institution wouldn't hire albinos. True, none may be on staff, but how many applied?

- H

I've done a lot of "asking around" re: peds EM as I have always wondered if it might be an interest in the future. I asked at my program (which is a children's hospital with dedicated ED) and at the pedi EM fellowship about 15 miles away. The PD at the peds EM fellowship said that about 1/4 of their apps last year were from EM trained folks. None were ranked high enough to match (and this is at a place where there is BOTH a peds program and an EM program).

I see what you mean about the application bias, but I have believe that EM-trained folks put in applications to places like CHOP, Boston Children's, and Cincinatti Children's. It might be a small portion, given the pay cut an adult and peds EM doc will take at a purely children's hospital, but I have a hard time believing that out of 20+ faculty there wasn't at least one well-qualified pedi EM doc who applied.

I really don't want to argue, and I don't care to belabor this point much further, especially since people seem to be dismissing my (thoroughly researched) stance. Yes, it may be a "bias" on the part of the pediatrics folks, but when they are doing the hiring then I guess you've gotta play the game. For someone's whose dream it is to work in the ED in a pediatric hospital, I think it's especially important to know what the biases are and make choices so that they aren't blindsided by any closed doors after residency and fellowship ('cause that would be the, what, 600K mistake?).

 

[FoughtFyr]

I've done a lot of "asking around" re: peds EM as I have always wondered if it might be an interest in the future. I asked at my program (which is a children's hospital with dedicated ED) and at the pedi EM fellowship about 15 miles away. The PD at the peds EM fellowship said that about 1/4 of their apps last year were from EM trained folks. None were ranked high enough to match (and this is at a place where there is BOTH a peds program and an EM program).

I see what you mean about the application bias, but I have believe that EM-trained folks put in applications to places like CHOP, Boston Children's, and Cincinatti Children's. It might be a small portion, given the pay cut an adult and peds EM doc will take at a purely children's hospital, but I have a hard time believing that out of 20+ faculty there wasn't at least one well-qualified pedi EM doc who applied.

I really don't want to argue, and I don't care to belabor this point much further, especially since people seem to be dismissing my (thoroughly researched) stance. Yes, it may be a "bias" on the part of the pediatrics folks, but when they are doing the hiring then I guess you've gotta play the game. For someone's whose dream it is to work in the ED in a pediatric hospital, I think it's especially important to know what the biases are and make choices so that they aren't blindsided by any closed doors after residency and fellowship ('cause that would be the, what, 600K mistake?).

I'm not trying to argue, nor dismiss your research. I guess the number that I would research is the number of EM applicants to peds EM fellowships. My suspicion (based on the folks I know) is that the number is very low. If so, then I do wonder if there exists the bias you are concerned about. I also wonder, given the relative paucity of Peds EM boarded physicians versus the number of positions nationwide, if that many facilities can afford to be that choosy. There are still a number of hospitals who host fellowships whose faculty are not fully peds EM boarded. Lastly, I wonder if some of the bias is in fact bias against peds and EM boarded folks (i.e., not peds EM boarded) as these were a hot political problem a few years back.

All of that said, if you really do dream only of practicing peds EM, as much as we'd hate to lose you, you should probably do a peds residency followed by a peds EM fellowship. If you try this, be sure to get as competitive a residency spot as you can. The peds EM fellowship match is VERY competitive (one of my best friends just went through it...).

- H

 

[SoCuteMD]

I'm not trying to argue, nor dismiss your research. I guess the number that I would research is the number of EM applicants to peds EM fellowships. My suspicion (based on the folks I know) is that the number is very low. If so, then I do wonder if there exists the bias you are concerned about. I also wonder, given the relative paucity of Peds EM boarded physicians versus the number of positions nationwide, if that many facilities can afford to be that choosy. There are still a number of hospitals who host fellowships whose faculty are not fully peds EM boarded. Lastly, I wonder if some of the bias is in fact bias against peds and EM boarded folks (i.e., not peds EM boarded) as these were a hot political problem a few years back.

All of that said, if you really do dream only of practicing peds EM, as much as we'd hate to lose you, you should probably do a peds residency followed by a peds EM fellowship. If you try this, be sure to get as competitive a residency spot as you can. The peds EM fellowship match is VERY competitive (one of my best friends just went through it...).

- H

You can't get rid of me THAT easily!