EM Residencies with good Peds ER exposure?

[mfish714]

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Hey all-

I know I'm only a lowly MSII, but I'm currently in the process of scoping out EM Residencies to keep myself motivated (and of course to start getting an idea of what programs would be a good fit for me eventually). I've had my fair share of clinical experience, and I've fallen in love with the ED. I'm hoping to do an EM residency and then a Peds ER fellowship and go on to work either at a Peds Hospital (hospital of my dreams = Cincy Children's) or work in an ED with a separate Peds ER. I know that a Peds residency is probably preferable, but if I don't find a job right away in a Peds ER, I don't have very much interest in doing Peds - so I'd like to go the ER route. I was hoping someone might be able to give me a little insight as to which programs have more exposure during the residency to pediatric populations. Any other advice/comments/suggestions are also welcome!!

Thanks
-mfish714

P.S. Any thoughts on the four year vs. three year format?

 

[CS_22]

Well, I can only speak for my program, but I know here at Wash U we spend ~20% of our shifts every month working at St Louis Children's Hospital ED (#3 Children's ED in the country). We staff these patients with the Peds EM attendings just the same as we do in the adult ED.

CS

 

[CoolEM]

The Ohio State University EM program has one of the best Peds EM exposures. Residents spend 7 months at the Nationwide Children's Hospital ED (>125,000 visits a year). We essentially run the dept with the Peds EM fellows and attendings. There is incredible responsibility and exposure to pathology. You will freqently run major resuscitations and intubate. The residency has been described as having a mini peds fellowship experience. Check it out.....

 

[bulgethetwine]

Hey all-

I know I'm only a lowly MSII, but I'm currently in the process of scoping out EM Residencies to keep myself motivated (and of course to start getting an idea of what programs would be a good fit for me eventually). I've had my fair share of clinical experience, and I've fallen in love with the ED. I'm hoping to do an EM residency and then a Peds ER fellowship and go on to work either at a Peds Hospital (hospital of my dreams = Cincy Children's) or work in an ED with a separate Peds ER. I know that a Peds residency is probably preferable, but if I don't find a job right away in a Peds ER, I don't have very much interest in doing Peds - so I'd like to go the ER route. I was hoping someone might be able to give me a little insight as to which programs have more exposure during the residency to pediatric populations. Any other advice/comments/suggestions are also welcome!!

Thanks
-mfish714

P.S. Any thoughts on the four year vs. three year format?

Acutally, I think you've got it *exactly* right -- EM residency followed by Peds fellowship if you want to be a peds EMer. A Peds residency is not preferable -- in fact, many places preferentially hire those who are EM residency trained for their Peds ED.

If you're doing a fellowship, the 3 vs. 4 year route is a no-brainer.... do the 3 year.

Good luck.

 

[SoCuteMD]

Acutally, I think you've got it *exactly* right -- EM residency followed by Peds fellowship if you want to be a peds EMer. A Peds residency is not preferable -- in fact, many places preferentially hire those who are EM residency trained for their Peds ED.

If you're doing a fellowship, the 3 vs. 4 year route is a no-brainer.... do the 3 year.

Good luck.

Depends on where you are talking about. I've been told by the pedi EM guys at my med school (dedicated children's hospital) that they only hire peds ---> peds EM. They also claim that this holds true in the Northeast.

 

[southerndoc]

One word of advice: I would certainly make sure I try to match into an EM program that is affiliated with a peds EM fellowship.

Most programs will give you good peds exposure as this is one of the things the RRC tries to ensure in its accreditation process. I think it is more important that you match at a place that has a fellowship where you can make friends with faculty members who have contacts at various fellowship programs. You should also be heavily involved with research as pediatric EM can be competitive.

 

[bulgethetwine]

Depends on where you are talking about. I've been told by the pedi EM guys at my med school (dedicated children's hospital) that they only hire peds ---> peds EM. They also claim that this holds true in the Northeast.

Honestly, the only ones who say this are the peds trained/EM fellowship. If you go to the national meetings, you'll find plenty of job opportunities -- demand WAY outstripping supply -- for the EM trained/Peds fellowship. I would certainly challenge the assertion that the Northeast favors the peds residency/EM fellowship type.

I've known many of each type, and although it is somewhat of a generalization, I find the EM residency trained seem to function much better. And they don't have to go running for a Harriett Lane every time they want to start a damn IV or administer a medication. They're also much more comfortable with pediatric trauma. I think that as far as "peds EM" goes, it's 80% emergency medicine, 20% pediatrics. Besides, we all know pediatrics is just adult medicine for little people. 😉 (an inflammatory statement to the pediatricians to be sure, but as Rick and Jerry say, it's more true than not) 👍

 

[bulgethetwine]

One word of advice: I would certainly make sure I try to match into an EM program that is affiliated with a peds EM fellowship.

Most programs will give you good peds exposure as this is one of the things the RRC tries to ensure in its accreditation process. I think it is more important that you match at a place that has a fellowship where you can make friends with faculty members who have contacts at various fellowship programs. You should also be heavily involved with research as pediatric EM can be competitive.

Well, as far as glad-handing a relationship, Southern is right -- you can potentially smooth your entrance into a program. But the other side of the coin is that an EM residency program with a fellowship tract means that there is another senior around siphoning off your experience and procedures. I'd say it's a wash.

 

[SoCuteMD]

Honestly, the only ones who say this are the peds trained/EM fellowship. If you go to the national meetings, you'll find that the greater proporiton is EM/Peds fellowship. I would certainly challenge the assertion that the Northeast favors the peds residency/EM fellowship type.

I've known many of each type, and although it is somewhat of a generalization, I find the EM residency trained seem to function much better. And they don't have to go running for a Harriett Lane every time they want to start a damn IV or administer a medication. They're also much more comfortable with pediatric trauma. I think that as far as "peds EM" goes, it's 80% emergency medicine, 20% pediatrics. Besides, we all know pediatrics is just adult medicine for little people. 😉 (an inflammatory statement to the pediatricians to be sure, but as Rick and Jerry say, it's more true than not) 👍

You may challenge my assumption, but my experience is that of the 4 pedi EM attendings at my school's children's hospital, all did Pedi ---> Pedi EM. At the site where all but one of our attendings did their fellowship, everyone is peds trained as well.

At CHOP, all of the attendings whose bios I paged through (about 3/4) were Pedi ---> Pedi EM or just straight Pedi. At Boston Children's I counted 2 EM trained (both were older), a few straight pedi, and the majority pedi ---> pedi EM. At Cinci, 8 of the 9 fellows are peds trained, most of the faculty appear to be pediatricians with EM fellowships as well. If you want a job at a dedicated children's hospital in the Northeast, then clearly there is a defined path through which to pursue it.

I made no statements about who is the "better" EM practitioner, and certainly EM training followed by a pedi EM fellowship makes you far more marketable in smaller places. However, the OP stated that his/her dream situation was a position in an ED at a dedicated children's hospital and clearly those hospitals have a preference for hiring pediatrics-trained physicians.

 

[bulgethetwine]

You may challenge my assumption, but my experience is that of the 4 pedi EM attendings at my school's children's hospital, all did Pedi ---> Pedi EM. At the site where all but one of our attendings did their fellowship, everyone is peds trained as well.

.

I'm not challenging your assumption as a personal act of aggression -- I'm just stating, for the benefit of the OP, that having been in EM for several years and having attended many national meetings and crossed paths with many in the profession, my estimation is that it is not a predominant peds residency/EM fellowship trained crowd. I leave it up to the OP to form their own opinion after reading yours, my, and others' posts. Plus, I might point out that your observation is limited to only a select (small) number of institutions, and you even point out that nearly all your attendings did their fellowship at the same spot... I suspect an inherent "inbreeding effect" might be present.

At CHOP, all of the attendings whose bios I paged through (about 3/4) were Pedi ---> Pedi EM or just straight Pedi. At Boston Children's I counted 2 EM trained (both were older), a few straight pedi, and the majority pedi ---> pedi EM. At Cinci, 8 of the 9 fellows are peds trained, most of the faculty appear to be pediatricians with EM fellowships as well. If you want a job at a dedicated children's hospital in the Northeast, then clearly there is a defined path through which to pursue it.

Both of these institutions have advertised in EM periodicals job vacancies for some time. I suspect they will take what they can get as evidenced by the large number of straight pedi clinicians. And your point about there being a "defined path" to pursue it is currently true, but the trend nationally is not one of preference for straight peds trained.

The OP stated that his/her dream situation was a position in an ED at a dedicated children's hospital and clearly those hospitals have a preference for hiring pediatrics-trained physicians.

Ok, well, like I said -- the OP should make up their own mind after reading all the posts. But SoCute's experience is, at the end of the day, that of a medical student in one particular region of the country. The statement that children's hospitals have a preference for hiring pediatrics-trained physicians is just not supported by my experience and in conversations I have had with many community and academic physicians across the country.

Sorry SoCute, not trying to piss you off -- just trying to provide a balanced view for the OP.

 

[el_chavo]

I asked this on another thread but this one's getting more traffic.
Is it possible or likely if you are EM trained -> peds EM to be able to work half in a peds ED and half in an adult ED? Do people do that?
I like working with kids more than adults but adults have cooler diseases than kids. Or do you just end up working with one population?
thanks

 

[deleted109597]

I asked this on another thread but this one's getting more traffic.
Is it possible or likely if you are EM trained -> peds EM to be able to work half in a peds ED and half in an adult ED? Do people do that?
I like working with kids more than adults but adults have cooler diseases than kids. Or do you just end up working with one population?
thanks

You probably could, but I would bet you would have more luck working at a place that has a Children's ED built into the adult hospital than working in two separate facilities.

 

[southerndoc]

Well, as far as glad-handing a relationship, Southern is right -- you can potentially smooth your entrance into a program. But the other side of the coin is that an EM residency program with a fellowship tract means that there is another senior around siphoning off your experience and procedures. I'd say it's a wash.

That's not been my case at all. We have a fellowship program, and I've done quite a few pediatric intubations, central lines, conscious sedations, etc.

 

[southerndoc]

.I'm not challenging your assumption as a personal act of aggression -- I'm just stating, for the benefit of the OP, that having been in EM for several years and having attended many national meetings and crossed paths with many in the profession, my estimation is that it is not a predominant peds residency/EM fellowship trained crowd.

I hope these aren't ACEP/AAEM national meetings, as a peds->peds EM trained physician would usually not be present for those since he/she had no prior EM experience before fellowship.

 

[SoCuteMD]

I asked this on another thread but this one's getting more traffic.
Is it possible or likely if you are EM trained -> peds EM to be able to work half in a peds ED and half in an adult ED? Do people do that?
I like working with kids more than adults but adults have cooler diseases than kids. Or do you just end up working with one population?
thanks

I agree with what McNinja said. This will make you very marketable at a place that employs both pedi EM trained and EM trained physicians, actually.

 

[BKN]

You may challenge my assumption, but my experience is that of the 4 pedi EM attendings at my school's children's hospital, all did Pedi ---> Pedi EM. At the site where all but one of our attendings did their fellowship, everyone is peds trained as well.

At CHOP, all of the attendings whose bios I paged through (about 3/4) were Pedi ---> Pedi EM or just straight Pedi. At Boston Children's I counted 2 EM trained (both were older), a few straight pedi, and the majority pedi ---> pedi EM. At Cinci, 8 of the 9 fellows are peds trained, most of the faculty appear to be pediatricians with EM fellowships as well. If you want a job at a dedicated children's hospital in the Northeast, then clearly there is a defined path through which to pursue it.

I made no statements about who is the "better" EM practitioner, and certainly EM training followed by a pedi EM fellowship makes you far more marketable in smaller places. However, the OP stated that his/her dream situation was a position in an ED at a dedicated children's hospital and clearly those hospitals have a preference for hiring pediatrics-trained physicians.

This is a very confused thread. Not surprising, since it's a very confused subject. SoCute, I picked your thread to quote just because you've got detail, not because I'm replying/arguing with you in particular.

The following is IMnotHO. Don't shoot me, it's only my notHO. I base it upon being an adult EM guy who has always practiced in a mixed ED with lots of kids. I've trained two pediatricians in adult em and I emphasize pediatrics very strongly in our curriculum.

1. Most pediatric EM visits will continue to be delivered in Adult EDs. The Peds EM people agree, see the APLS text.
2. The reasons that peds to ped-em fellowship types predominate at Peds hospitals are that:

a. There are many more of them
b. General EM grads don't often do this fellowship because:

1. They already feel qualified to take care of child emergencies (I'm not saying they are right, see addedendum)
2. They probably will take a cut in pay if in a PEDs EM practice (Pediatricians go up)
3. Adrenaline driven EPs consider Peds EM a little dull, with a fairly narrow range of disease, and most kids not very ill. (obviously, there are occasional spine-chilling exceptions)

3. Major peds trauma will continue to go to the Adult trauma centers in all but the biggest cities with contiguous adult and pediatric university hospitals. Peds hospitals by themselves will rarely be able to support all the components of a level 1 or 2 trauma team.
4. The combination of a peds residency and em residency or em residency/peds em fellowship gives identical training and capabilities and the qualifications to see adults as well. The peds/peds em fellowship does not. The peds res/em res does not allow one to sit for the subspecialty boards, but if you're already qualified for both boards, you've exceeded it.
5. If the peds em people are expressing a preference to peds to ped em fellowship types over peds boarded/em boarded em to peds em fellowship it reflects:

1. self-interest
2. such people are easier to hire since there are few of the other two.

ADDENDUM: I do not think that most General EM grads are quite trained for the full range of Peds EM. I think most should have some time in a dedicated Peds ED (just as in ICUs, on Ortho etc). In addition I strongly recommend the Advanced Pediatric Life Support (APLS) course and textbook sponsored by AAP and ACEP. This is not Pediatric Advanced Life Support (PALS). Confusing, I know. PALS is a resucitation course similar to ACLS. APLS is really a survey of Peds EM and a truly superior course. I honor the Peds EM faculties for seeing the need both for general pediatricians and general EPs and creating it. I am a course director and we have been giving a very complete version of the course to our residents and the pediatricians at our campus.

Well it's been a long time since I did one of my full rants. The rest is silence.

 

[tegs15]

Just an M2 myself, but I'm pretty sure that Maricopa EM residents spend a lot of time at Phoenix Childrens Hospital.
😕

 

[seldomseen]

Just an M2 myself, but I'm pretty sure that Maricopa EM residents spend a lot of time at Phoenix Childrens Hospital.
😕

Maricopa is probably better than some, worse than others, with about 6 months of Peds exposure over the residency...

1 dedicated month in the Maricopa peds ED with peds ED shifts integrated into regular ED months over all 3 years for added exposure and continuity. At 2-3 12 hour shifts a month, that works out to about 4 months of peds ED at the Maricopa site.

1 month of dedicated peds ED at Phoenix childrens (great pathology)

1 month of PICU at Phoenix Childrens (not ED per se, but very worthwhile).

After first year, it is quite popular to moonlight at the Phoenix children's ED for extra peds exposure, $, and that first scary taste of independence.

 

[Seaglass]

You may challenge my assumption, but my experience is that of the 4 pedi EM attendings at my school's children's hospital, all did Pedi ---> Pedi EM. At the site where all but one of our attendings did their fellowship, everyone is peds trained as well.

Actually I bet this is more of a supply demand thing - less EM grads do fellowships especially peds because it is a pay cut - so there are a lot more peds - peds em people than Em - Peds EM people. Just a plug for Wake Forest - all the residents that applied for peds EM from there had their choice of fellowships.