EM/Peds or EM then Peds ER fellowship for rural?

[nowonder]

Starting school this fall and starting to think about (way too early, I know) plans. I'll throw this question out if anyone has an opinion.

I've got an interest in EM, volunteered in a Level I for two years, so I kind of know what I'm looking at. What I think I'd like to do after training is do locum tenens and bounce around rural areas for a few years. (That may or may not be the best idea, but out of scope for this discussion).

My thought is this: To have the most options, and to be of most use in a rural setting, I should have both an EM and Peds background. In an ideal world, would it be better to do a combined EM/Peds residency or EM then Peds ER fellowship? I don't really intend to work at a dedicated Children's ED and certainly don't see myself in academia, but I wonder if the fellowship would make more prepared to treat acute peds patients in an emergent case. But I wonder if I'm board certified in Peds, if I'm going to end up being sucked in to covering peds patients and away from the ED.

Thoughts?

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[Birdstrike]

If you have any interest in ever being a Pediatrician do EM/peds combined. If you want to be subspecialty boarded in peds ER, ie, be a peds ER doctor, then do ER then peds ER fellowship. They are 2 different pathways now, and I don't think you can get Peds ER boarded by doing a pediatrics residency and "grandfathering in", anymore (peds EM docs please clarify).

By the way, if you want to be an ER doc in a rural setting, not only do you not need to have a peds/ER fellowship, you don't even have to be board certified in Emergency Medicine. IM or FP will suffice in some rural hospitals due to the severe national ER physician shortage (~40%).

 

[gutonc]

If you have any interest in ever being a Pediatrician do EM/peds combined. If you want to be subspecialty boarded in peds ER, ie, be a peds ER doctor, then do ER then peds ER fellowship. They are 2 different pathways now, and I don't think you can get Peds ER boarded by doing a pediatrics residency and "grandfathering in", anymore (peds EM docs please clarify).

By the way, if you want to be an ER doc in a rural setting, not only do you not need to have a peds/ER fellowship, you don't even have to be board certified in Emergency Medicine. IM or FP will suffice in some rural hospitals due to the severe national ER physician shortage (~40%).

Pediatricians can still do a Peds EM fellowship (2 years?) while an EM/Peds program will require significant training in adult EM.

If your goal is both Peds and Peds EM, the Peds//>PEM path is probably a better route (training time is the same). But if you want to do EM with a Peds focus, I agree that EM/Peds is the way to go.

 

[dchristismi]

Fellowships are not the end-all-be-all that those in academia make them out to be.

If you want to work in the ED, do a residency in EM. If you decide you love working with children to the point that you want to work at a Children's hospital, do a Ped-EM fellowship afterwards. But you certainly don't need it - you will get exposure to pediatrics as part of residency. And yes, you will get enough.

I'm not technically "rural," although I do practice in a small town. (Or am I? There are a lot of cows here... anyway...) My hospital does not admit children under the age of 5 at all, or anyone under the age of 18 who requires oxygen/monitoring, so we ship 99% of our peds cases that need to be admitted. You get used to it. Stabilize, ship. Certainly doesn't take a fellowship-trained doc to do that.

"Um, hi, Ivory Tower Transfer Center? This is Dr. Me at Podunk General. I have a RSV+ 9 month old satting 90% on 1L, will you accept?"


Doing a fellowship if you don't intend to specialize in that area or stay in academics is a waste of, oh, lets just say, lots of money you could be making as an attending.

Just my 2c

 

[KidDr]

Pediatricians can still do a Peds EM fellowship (2 years?) while an EM/Peds program will require significant training in adult EM.

If your goal is both Peds and Peds EM, the Peds//>PEM path is probably a better route (training time is the same). But if you want to do EM with a Peds focus, I agree that EM/Peds is the way to go.

Peds EM fellowship after peds residency is 3 years. So 6 years total. For me personally I always knew I wanted to work in emergency medicine but I also knew I only wanted to work with kids--so the Peds + PEM route made the most sense for me. I'm finishing up my fellowship this year and I'm glad I did it this way.

For your question, like others have said, if you can ever see yourself wanting to work as a general pediatrician, I would say do Peds/EM combined residency. Otherwise do EM + PEM fellowship (2 years if going this route)--but I would really only recommend doing this if you want to work in a dedicated children's hospital. For what you're describing (wanting to work in a rural area), you would probably be better off just picking an EM residency with very good peds exposure/experience and go with that.

 

[Hamhock]

"Um, hi, Ivory Tower Transfer Center? This is Dr. Me at Podunk General. I have a RSV+ 9 month old satting 90% on 1L, will you accept?"

I'm not sure I could not laugh, if I was on the receiving end...of course, I would understand where you are coming from and accept, but I will still laugh.

Just reading that is funny.

HH

One of our attendings figured out how to call our 'bat phone' (EMS only access for major medical/trauma) and will frequently call with BS to F with us. If I heard your requested transfer, I think my response would be: followed by "F off, Dr. .....".

HH

OP: if you want to do rural EM, do an EM residency. No more discussion.

HH

 

[nowonder]

OP: if you want to do rural EM, do an EM residency. No more discussion.

HH

Great advice, I appreciate it. So follow-up: Are there programs you're aware of that have have a strong rural component? (probable answer: One in a rural area, duh.)

 

[Birdstrike]

Peds EM fellowship after peds residency is 3 years. So 6 years total. For me personally I always knew I wanted to work in emergency medicine but I also knew I only wanted to work with kids--so the Peds + PEM route made the most sense for me. I'm finishing up my fellowship this year and I'm glad I did it this way.

For your question, like others have said, if you can ever see yourself wanting to work as a general pediatrician, I would say do Peds/EM combined residency. Otherwise do EM + PEM fellowship (2 years if going this route)--but I would really only recommend doing this if you want to work in a dedicated children's hospital. For what you're describing (wanting to work in a rural area), you would probably be better off just picking an EM residency with very good peds exposure/experience and go with that.

Can you get board certified in Emergency Medicine by doing a peds residency then PEM fellowship? Just curious.

 

[Birdstrike]

Great advice, I appreciate it. So follow-up: Are there programs you're aware of that have have a strong rural component? (probable answer: One in a rural area, duh.)

Emergency medicine is emergency medicine. Go to the best program you can get into. You all read the same book.

 

[jbar]

Can you get board certified in Emergency Medicine by doing a peds residency then PEM fellowship? Just curious.

No, you'd be boarded in Pedi EM, and Peds, but not adult EM. You couldn't working in an adult ED with that training.

 

[DeadCactus]

Peds EM fellowship after peds residency is 3 years. So 6 years total. For me personally I always knew I wanted to work in emergency medicine but I also knew I only wanted to work with kids--so the Peds + PEM route made the most sense for me. I'm finishing up my fellowship this year and I'm glad I did it this way.

For your question, like others have said, if you can ever see yourself wanting to work as a general pediatrician, I would say do Peds/EM combined residency. Otherwise do EM + PEM fellowship (2 years if going this route)--but I would really only recommend doing this if you want to work in a dedicated children's hospital. For what you're describing (wanting to work in a rural area), you would probably be better off just picking an EM residency with very good peds exposure/experience and go with that.

Do Peds/PEM folks generally switch to a straight PEM practice or do they continue doing general pediatrics to some extent?

 

[dabearsdacoach]

In a rural setting you have to be able to see adults. Strictly Peds EM is children's hospital/dedicated Peds ED niche- which for the most part doesn't exist in rural settings. If you want to work in a rural area do an EM residency and then a peds EM fellowship if you want the added peds experience. However, I feel most EM residencies provide sufficient experience to feel confident with most peds emergencies...that said, peds codes are always sphincter tightening...no way around it.

 

[Arcan57]

Many rural hospitals cannot attract EM trained physicians. They would have no idea what to do with a peds-EM doctor. It'd be like applying to become a barista at Starbucks after finishing med school.

 

[KidDr]

Do Peds/PEM folks generally switch to a straight PEM practice or do they continue doing general pediatrics to some extent?

The hospital group I work with has almost 30 PEM docs--none (as far as I know) are still involved in general pediatrics to any significant degree. Several came to a PEM career after doing general peds for awhile (they did a fellowship after practicing in gen peds). It (gen peds practice) could be a nice fallback, I guess, if one gets tired of working nights as they get older. But the salary trade-off is pretty significant. I can't see myself doing it (I can't stand gen peds clinic), but yet I'm still planning to keep up my general peds certification (just in case...) and I think many of my colleagues do as well.

 

[Stitch]

The hospital group I work with has almost 30 PEM docs--none (as far as I know) are still involved in general pediatrics to any significant degree. Several came to a PEM career after doing general peds for awhile (they did a fellowship after practicing in gen peds). It (gen peds practice) could be a nice fallback, I guess, if one gets tired of working nights as they get older. But the salary trade-off is pretty significant. I can't see myself doing it (I can't stand gen peds clinic), but yet I'm still planning to keep up my general peds certification (just in case...) and I think many of my colleagues do as well.

This is my experience as well. I've seen a couple 'retire' into gen peds, but most are doing PEM and not general practice. Most I know couldn't stand working in an office. Not to mention your schedule could be very difficult on you and your partners. You'd have to work night shifts and a certain number of clinic days; believe me when I say you don't recover from night shifts all that easily as you get older.

On the other hand, PEM sees a LOT of general peds issues, so you are still seeing a lot of well kids, constipation, otitis, and keeping up your cert in gen peds is a good idea.

 

[KidDr]

This is my experience as well. I've seen a couple 'retire' into gen peds, but most are doing PEM and not general practice. Most I know couldn't stand working in an office. Not to mention your schedule could be very difficult on you and your partners. You'd have to work night shifts and a certain number of clinic days; believe me when I say you don't recover from night shifts all that easily as you get older.

On the other hand, PEM sees a LOT of general peds issues, so you are still seeing a lot of well kids, constipation, otitis, and keeping up your cert in gen peds is a good idea.

Yes...for better or for worse, the peds ED oftentimes becomes like one big peds urgent care, and on especially painful days I end up having to address lots of primary care issues like behavior, obesity, immunization refusers, and so on. For the most part I try to refer people back to their PMD, but sometimes you can't avoid the conversations. It's a good reminder of why I did fellowship!