EM residency after finishing FM. Need advice please.

[Odaleyguey11]

Hello.

I have been scouring SDN for answers and have found some good information regarding my issue but have not been able to find posts that directly address my main question. Please link me if I missed anything.

My main questions to you all are:

1. What is the likelihood, in this day and age, of successfully matching to an EM residency as someone who has completed FM training?
- From calling a number of PDs it seems my main hurdle (if otherwise academically qualified) will be reduced medicare funding. Agree?

2. Is it legal/possible to cover the lacking funds? Or is that an ethical issue?
- I spoke with someone at the AAMC and according to them the hospital would be out approx 10-20K a year. I can cover 30-60K, especially since I will be working as an attending for a year before matriculation in ED (if accepted).

I am currently a PGY2 FM resident. I graduate in July of 2019. During the last year and a half I have fallen in love with EM. I am planning on applying to EM residencies during the 2019-2020 ERAS cycle (matriculating June/July of 2020). I was not adequately exposed to EM during med school and did not consider it until my first EM rotation during residency. Out of all my rotations before and since, I've connected and resonated most with the pace, people and type of medicine practiced in EM. Besides the odd hours it truly is the "the most interesting 15 minutes of every other specialty" for me. I have rotated through just about every specialty and sub specialty at this point and by far, EM has been the most enjoyable, educational, inspirational and engaging rotation.

I understand that the specialty is far from perfect, has a high (highest?) burn out rate and the hours are tough. I know that reduced funding will be a very difficult, if not insurmountable, hurdle to overcome. I’ve had one PD look at my CV and say: “we would love to interview you but would not be able to take you on due to the funding deficiency”. A little discouraging; nevertheless, I intend to press on.

Brief summary of me “on paper” by request:
· DO
· No red flags, failures or bad reviews in med school or residency.
· MS I/II grades were all A's and B's with a couple C's (nephro and electrophys--I stink at math).
· MS III/IV all rotations were High Pass or Honors.
· COMLEX I, II, III: 547, 618, 655. No USMLE…(would it help if I take USMLE Step 2?)
· PGY1 In Training Exam was highest in class, well above national mean. PGY2 ITE was well above national mean, 2nd highest in class.
· I'm a Fulbright Fellow (like a Rhodes or Watson scholarship, with State Department), have a Masters in Middle East Studies and have a bunch of other "life-experiences” and extra curriculars like extensive medical missions, I’m a therapy dog trainer, former Israeli EMT, and other similar “soft points”.

My plan at this time (Please feel free to add/modify/correct/comment. I’ll be adjusting my plan and expectations as I proceed):

1. Call PDs of every EM program that has a DO in their residency class or core faculty and asking them the above question, reworded appropriately.

2. Apply to every viable EM program in the country that I have a chance at.

3. Schedule as many electives as possible in our ED. My hospital does not have an EM residency, unfortunately.

4. Keep grabbing shifts in the ED during my weekends/time off.

5. I start moonlighting in Urgent Care this July.

6. Get SLOEs from my EM attendings and EM director.

7. Work with my program to get funding for an away rotation at a viable EM residency ASAP.).

8. Lastly, in case there was any confusion, I will definitely be completing my FM training.

Good plan? Any suggestions??

Thank you.

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[deleted497653]

Hi,

I'm surprised no one has responded. What you are trying to do has been done before (or thought about by many). There are several things to consider. I'm short on time but for the most part I would advise you to try to make your current chosen field (FM) work for you. Emergency medicine has it's short comings. The team aspect you describe is present in all fields to an extent, the OR, the office, the ER, urgent care etc. It's just different. I'm not sure the team aspect is a good enough reason to consider changing fields. Your team is dependent on who is currently working there.

Have you paid off your loans? Returning to residency for a second field is also a financial decision. Your loans will be accruing interest while you're in residency

Are there other things you like to do outside of work? At some point even EM is just work- a job. So is family medicine. A calling on the high end and on other days, just a job to pay the bills. You might not see it this way but for the most part, being a family doctor is a good job just like EM.

Only you can decide if it's worth applying for residency. Also remember just applying is the first huddle, then you have to make it through residency. A lot of places will not consider you for residency for a myriad of reasons. It seems like you feel that funding is the biggest reason but there are other nebulous reasons to consider a fresh med school grad over someone who has already finished another residency. This is a topic that can take a while to discuss but essentially, your best time to pick a field is while in medical school.

Good luck in your decision! Choose wisely.

 

[Giovanotto]

(I'm sure you've considered this, but you never know) What about urgent care work? Not as exciting perhaps, but maybe the setting will be closer to EM than say outpatient FM? Just a thought. Only an OMS2 so I can't really help you with the rest.

 

[alexalex]

First, I'm not sure still what aspects of em are making you want to switch from fm. Comraderie sure, but as an attending doctor you will be pretty much on your own at most community sites. The immediate impact? Sometimes, but having a good fm doc is probably best for having a lasting impact in someone's health. FM has lots of procedures, better hours, and flexibility on practice depending what state your work at. Have you considered sports medicine fellowship?

Now realistically speaking in terms of your chances is hard to tell because it is rare to see this and it's hard to know how PDs look at these applicants (if at all given funding issues). However, in the chance that funding is not an issue, many things remain.
- SLOEs are probably the most important thing in an application nowadays and these are to come ideally from a place with an EM residency. One at the very least would be required in most places.
- EM is more competitive than it used to be, and they may still care or look at your medical shcool performance and board scores, so maybe share some basics on that. You would be competing against fresh grads with EM related activities, with multiple SLOEs, with higher reserves for night shifts and crappy hours.
- Time investment / personal life: You mentioned no SO or children now, but if that is anywhere in your plans, your time is valuable and you should take those things into account.
- Financial burden: Look at your years of productivity vs years invested I'm education/training. You would be working for how many years after finishing residency in your 40s? Do you have a significant debt at this point? That really should play a role in your decision making

Your best shot would be prior DO programs, new programs, undesirable geographical locations. It likely can be done, I've seen people switching from other specialties into EM. The question is whether you think it is worth it and whether you are willing to make other things in your life wait.
Good luck.

 

[hamstergang]

2) If your program does consider applicants with previous training, would it be possible to arrange a clerkship or visiting resident rotation?
I understand that there may be insurance or additional funding issues with that as well and have begun the process of petitioning my program for permission and assistance. If necessary, I would be happy to fund my rotation out of pocket if it is within my financial means.

I'm not sure if you can legally fund a rotation on your own. I'm fairly certain you can't fund your entire residency, at least.

 

[Odaleyguey11]

Thank you all. I appreciate the candor and advice.
I welcome any more advice, thoughts, insights, admonitions, etc.

 

[Odaleyguey11]

Thanks Alexalex. I edited my original post to answer your questions. Greatly appreciated your insights.

 

[Old_Mil]

I am currently a PGY2 FM resident. I graduate in 2019. During the last year and a half I have fallen in love with EM. I was not adequately exposed to EM during med school and did not consider it until my first EM rotation during residency.

8. As a final option/resort: Contact the FM- EM Fellowship programs and see what the end results of their programs are (employment, locations, pay, etc).

9. Lastly, just in case there was any confusion, I will definitely be completing my FM training.

Good plan? Any suggestions??

Thank you.

Given the current state of affairs in medicine, you're on the verge of ruining your career. The combination of EMTALA and the ACA have hit EM the hardest in all the house of medicine because we lack the ability to work outside the hospital easily, lack the ability to withdraw from CMS, lack the ability to cap our practice, and lack the ability to turn away patients.

So rest assured by going into FM you've made a wise choice given where the pieces on the chess board are today.

Do not consider going back into a second residency. If you really want to sample EM, do a fellowship and do some moonlighting. You'll soon see the reasons why what I'm saying makes sense.

 

[Kach]

My very first job out of fm residency was an intense em 35k trauma level 3 gig. Within 1-2 months and with the help of my em trained co-workers I basically felt comfortable. The pay was excellent and comparable to other EMs. So I recommend you tailor your fm electives for working in the ed when your done. Don't let anyone on this website prevent you or suggest that you can't do this. I get calls everyday for ed work as an fm. Second, there are about 15 boarded fellowships (not abem but aaps) and about 10 other non boarded fellowships that provide an extra year of em training after residency. Please consider that. Finally you can redo residency.

 

[Odaleyguey11]

My very first job out of fm residency was an intense em 35k trauma level 3 gig. Within 1-2 months and with the help of my em trained co-workers I basically felt comfortable. The pay was excellent and comparable to other EMs. So I recommend you tailor your fm electives for working in the ed when your done. Don't let anyone on this website prevent you or suggest that you can't do this. I get calls everyday for ed work as an fm. Second, there are about 15 boarded fellowships (not abem but aaps) and about 10 other non boarded fellowships that provide an extra year of em training after residency. Please consider that. Finally you can redo residency.

Thanks for rhe insight!
How, when and where did you secure a job like that? Relatively recently or have you been an attending for a while now?

Would you mind sharing search engine/job boards/ services i can use to find similar positions? I will have almost 10M in the ED or UC if my elective and selective plan is accepted. Including shifts i take on my days off.I know that is not equivalent to a residency but its something.

Im still very concerned, based off of 7 PDs ive spoken to, that no program will consider my application based on funding deficits. Its not seeming as simple as being determined to do a second residency anymore. Thoughts?

 

[Kach]

Hey! See below

How - Locums companies, though you can call hospitals or EM groups directly.
When - right outta residency, 7/2017
Where - Michigan
How Did you secure a job like that? - They called me! And they call me everyday. Just gotta give your CV to a good recruiter.

Recently or have you been an attending for a while now? - graduated 10 months ago

Would you mind sharing search engine/job boards/ services i can use to find similar positions? - Google the words locums ED in your locale. call the locums number. Before you send your CV draft a letter requesting that the recruiter cannot send your CV to any company without your permission.

I will have almost 10M in the ED or UC if my elective and selective plan is accepted - Thats Plenty. I had 6 months plus anesthesia electives. I did an interventional radiology month and suddenly became their intern. I was doing lots of paracentesis/thoracentesis. I was very proactive during my ortho months as well. I did a lot of casting and steroid injections. I did a few reductions but most of my reductions were in the ED. On my floor months I made friends with the in house surgical residents and did central lines with them.

Expect 180-300 an hour depending on where you live. You will be a a 1099 which means you have to take out your own taxes. If you are hired by a hospital or group you might be perdiem, part time or full time. I'm telling you, groups have been offering me EM jobs left and right though they're all rural 12 hour shifts. Truth be told I was very nervous in my first few months, but after a few codes and intubations, you just get more confident. ALso remember that anyone can walk through the door, including a crazy trauma, stroke or stemi, but maybe three out of four cases are urgent care level or FM level cases that can be sent home. Finally, think of it this way, if a midlevel with no residency experience can do this, you can do it too. Yes, they work in the fast track, but in a busy ED in a rural environment, they are seeing physician level patients. Its just the fact.

All that said, out of respect for the field and for the sake of my career and my patients ill be doing an EM fellowship starting in July. SInce I'm sure my career will be in the ED I think its the right thing to do. I believe Experience + 1 year fellowship + rigorous board exam (written and oral, both patterned after ABEM) are probably more than enough to practice rurally or in a suburban area. I will blog about it on this website. In the meantime, I'm working in a rural ED as we speak.

 

[Odaleyguey11]

Hey! See below

How - Locums companies, though you can call hospitals or EM groups directly.
When - right outta residency, 7/2017
Where - Michigan
How Did you secure a job like that? - They called me! And they call me everyday. Just gotta give your CV to a good recruiter.

Recently or have you been an attending for a while now? - graduated 10 months ago

Would you mind sharing search engine/job boards/ services i can use to find similar positions? - Google the words locums ED in your locale. call the locums number. Before you send your CV draft a letter requesting that the recruiter cannot send your CV to any company without your permission.

I will have almost 10M in the ED or UC if my elective and selective plan is accepted - Thats Plenty. I had 6 months plus anesthesia electives. I did an interventional radiology month and suddenly became their intern. I was doing lots of paracentesis/thoracentesis. I was very proactive during my ortho months as well. I did a lot of casting and steroid injections. I did a few reductions but most of my reductions were in the ED. On my floor months I made friends with the in house surgical residents and did central lines with them.

Expect 180-300 an hour depending on where you live. You will be a a 1099 which means you have to take out your own taxes. If you are hired by a hospital or group you might be perdiem, part time or full time. I'm telling you, groups have been offering me EM jobs left and right though they're all rural 12 hour shifts. Truth be told I was very nervous in my first few months, but after a few codes and intubations, you just get more confident. ALso remember that anyone can walk through the door, including a crazy trauma, stroke or stemi, but maybe three out of four cases are urgent care level or FM level cases that can be sent home. Finally, think of it this way, if a midlevel with no residency experience can do this, you can do it too. Yes, they work in the fast track, but in a busy ED in a rural environment, they are seeing physician level patients. Its just the fact.

All that said, out of respect for the field and for the sake of my career and my patients ill be doing an EM fellowship starting in July. SInce I'm sure my career will be in the ED I think its the right thing to do. I believe Experience + 1 year fellowship + rigorous board exam (written and oral, both patterned after ABEM) are probably more than enough to practice rurally or in a suburban area. I will blog about it on this website. In the meantime, I'm working in a rural ED as we speak.

Thats really fantastic! Thank you very much for the reply. Which fellowship program, if you dont mind me asking? I believe i will not leave my particular FM residency as proficient in urgen/emergent procedures as i would like however. I will look for workshops and procedure labs.

 

[Kach]

Thats really fantastic! Thank you very much for the reply. Which fellowship program, if you dont mind me asking? - I dont wanna put all my business out there! But it doesn't matter. The significant thing is that it's a level 2 hospital with greater than 50000 patients a year. If you decide to do a fellowship make sure that they see at least 30000 patients per year. This will give you the experience that you need after a one-year Fellowship. As for trauma level it's best to look for a level 1 or 2 hospital however I found that there is plenty of pathology at level 3 and level 4 er's. The difference is that lower level emergency rooms transfer their patients whereas higher level emergency rooms admit their patients.

I believe i will not leave my particular FM residency as proficient in urgen/emergent procedures as i would like however. - To your point, I learned how to treat ocular injuries while Moonlighting in the Urgent Care, during my residency. And I learned much more as an attending . The point is that you will learn a lot on the job. Just do the best you can while in residency.

I will look for workshops and procedure labs - good idea. There are lots of workshops out there. I planned on doing them but I figured it would be less expensive and more beneficial to do the Fellowship instead. Fellowships tend to pay between 60 and $100,000 a year however most of them allow you to Moonlight which can really increase your income substantially. A former fellow at the program told me he made another 100k on top of his fellowship which is very doable if the hourly pay is good. Most fellowships require 12-15 shifts a month leaving you time to moonlight.

 

[Angry Birds]

1) Yes, it's definitely possible to work in some ER's around the country as an FP-trained person. In fact, if you are flexible with where you live, there exists no shortage of such positions. I myself work in a place where many of my colleagues are FP or IM-trained.

2) No matter how you slice it, the truth is that unless you take great efforts to counter this, you will likely not be a great EM doctor or equivalent to an EM-trained doctor. It doesn't matter if you work 20 years in an ER... The problem is that the 3-4 years of residency training is what makes an EM doctor. In 20 years of just working in the ER, you tend to take on bad habits and slop together a routine that works but is far from ideal. Usually when I get signed out cases by my non-EM trained colleagues, I have to change the work-up completely. This is not the case when I get sign-off from EM trained folks, even people fresh from residency. The non-EM people--many/most of them very senior doctors who have worked in the ER for many long years (longer than I have)--consistently over-test/treat unsick patients and under-test/treat sick patients. I also think they are much slower and unable to handle the crazy volume of a busy ER.

This leads to the question: is your desire to work in the ER so great that you want to do it even though you know you almost certainly won't be an adequately trained person to do well? I'm not saying that you can't slop something together and get by... You can and you will. But, you will likely always be far from ideal.

If you see my earlier posts on this thread, I used to think that there was no difference between someone who is EM-trained and a FP/IM person who has worked in the ER for 20 years. Now, I know better--after having worked with the latter group closely.

 

[Kach]

Cool.

 

[Odaleyguey11]

1) Yes, it's definitely possible to work in some ER's around the country as an FP-trained person. In fact, if you are flexible with where you live, there exists no shortage of such positions. I myself work in a place where many of my colleagues are FP or IM-trained.

2) No matter how you slice it, the truth is that unless you take great efforts to counter this, you will likely not be a great EM doctor or equivalent to an EM-trained doctor. It doesn't matter if you work 20 years in an ER... The problem is that the 3-4 years of residency training is what makes an EM doctor. In 20 years of just working in the ER, you tend to take on bad habits and slop together a routine that works but is far from ideal. Usually when I get signed out cases by my non-EM trained colleagues, I have to change the work-up completely. This is not the case when I get sign-off from EM trained folks, even people fresh from residency. The non-EM people--many/most of them very senior doctors who have worked in the ER for many long years (longer than I have)--consistently over-test/treat unsick patients and under-test/treat sick patients. I also think they are much slower and unable to handle the crazy volume of a busy ER.

This leads to the question: is your desire to work in the ER so great that you want to do it even though you know you almost certainly won't be an adequately trained person to do well? I'm not saying that you can't slop something together and get by... You can and you will. But, you will likely always be far from ideal.

If you see my earlier posts on this thread, I used to think that there was no difference between someone who is EM-trained and a FP/IM person who has worked in the ER for 20 years. Now, I know better--after having worked with the latter group closely.

I have to agree with you. Thats why Im actively researching the possibility of doing a residency in EM after finishing FM res in 2019. At first i thought the only hurdle would be the competitiveness of the specialty. Im finding that the funding issue might be an insurmountable hurdle. Im hoping for some insight from you all regarding the feasibility of getting considered by EM programs, assuming I'm qualified academically, even though I’ll have reduced funding due to my fm residency.

Id love to hear anything definitive, either yes or no. I agree that em residency is ultimately essential to working in em, especially since my family live in large cities.

 

[enalli]

I have to agree with you. Thats why Im actively researching the possibility of doing a residency in EM after finishing FM res in 2019. At first i thought the only hurdle would be the competitiveness of the specialty. Im finding that the funding issue might be an insurmountable hurdle. Im hoping for some insight from you all regarding the feasibility of getting considered by EM programs, assuming I'm qualified academically, even though ill have reduced funding due to my fm residency.

Id love ro hear anything definitive, eother yes or no. I agree that em residency is ultimately essential to working in em, especially since my family live in large cities.

I have been told that my hospital has more residents than it has medicare-funded spots. I assume this is the case at other hospitals too. The question is how these non-funded spots are allocated and if the EM PD would have access to these spots.

If I were you, I would email as many PDs as possible and see how it works at their hospital. I imagine this is something that is hospital-dependent and you don't have much to lose by emailing for clarification.

 

[enalli]

2) No matter how you slice it, the truth is that unless you take great efforts to counter this, you will likely not be a great EM doctor or equivalent to an EM-trained doctor.

The bolded point is really important. We have all been trained by fantastic attendings who never trained in EM (some who were grandfathered by ABEM and some who weren't). The key difference between them and your current colleagues is probably the fact that the former have been involved in a teaching program and as such are more likely to keep up with the literature.

 

[miacomet]

There are a ton of options within FM. You could do sports, hospitalist, OB fellowship. Try and find something that works for you. If you can't after a year or two, then apply for an EM fellowship.

 

[Angry Birds]

The bolded point is really important. We have all been trained by fantastic attendings who never trained in EM (some who were grandfathered by ABEM and some who weren't). The key difference between them and your current colleagues is probably the fact that the former have been involved in a teaching program and as such are more likely to keep up with the literature.

I agree. This is true. And I don't leave out the possibility that even a very motivated FP-trained person could become a good EM doctor. The odds are, however, that this will not happen.

For me, I see residency as what creates doctors, not medical schools. So, if you did not go to the residency associated to your field, for me that's like not going to medical school.

 

[SID8298]

1) Yes, it's definitely possible to work in some ER's around the country as an FP-trained person. In fact, if you are flexible with where you live, there exists no shortage of such positions. I myself work in a place where many of my colleagues are FP or IM-trained.

2) No matter how you slice it, the truth is that unless you take great efforts to counter this, you will likely not be a great EM doctor or equivalent to an EM-trained doctor. It doesn't matter if you work 20 years in an ER... The problem is that the 3-4 years of residency training is what makes an EM doctor. In 20 years of just working in the ER, you tend to take on bad habits and slop together a routine that works but is far from ideal. Usually when I get signed out cases by my non-EM trained colleagues, I have to change the work-up completely. This is not the case when I get sign-off from EM trained folks, even people fresh from residency. The non-EM people--many/most of them very senior doctors who have worked in the ER for many long years (longer than I have)--consistently over-test/treat unsick patients and under-test/treat sick patients. I also think they are much slower and unable to handle the crazy volume of a busy ER.

This leads to the question: is your desire to work in the ER so great that you want to do it even though you know you almost certainly won't be an adequately trained person to do well? I'm not saying that you can't slop something together and get by... You can and you will. But, you will likely always be far from ideal.

If you see my earlier posts on this thread, I used to think that there was no difference between someone who is EM-trained and a FP/IM person who has worked in the ER for 20 years. Now, I know better--after having worked with the latter group closely.

What about the fact that there are not enough EM trained docs to staff all the ERs in the US. Do you think that FP switching over to EM would be good for these roles or rather leave these ER's unstaffed?

 

[InternistDO]

What about the fact that there are not enough EM trained docs to staff all the ERs in the US. Do you think that FP switching over to EM would be good for these roles or rather leave these ER's unstaffed?

Those EDs are staffed--with family med doctors or NP/PAs. And if one day there's enough EM boarded doctors to go around, then they'll start to take those jobs. The only exception would be the super rural hospitals where the FM doctor in the ED is also the town's PCP, OBGYN, and hospitalist. Those places will probably stay FM forever.

 

[Birdstrike]

Hello.

I have been scouring SDN for answers and have found some good information regarding my issue but have not been able to find posts that directly address my main question. Please link me if I missed anything.

My main questions to you all are:

1. What is the likelihood, in this day and age, of successfully matching to an EM residency as someone who has completed FM training? From calling a number of PDs it seems my main hurdle (if otherwise academically qualified) will be reduced medicare funding. Agree?

2. Is it legal/possible to cover the lacking funds? Or is that an ethical issue? I spoke with someone at the AAMC and according to them the hospital would be out approx 10-20K a year. I can cover 30-60K, especially since I will be working as an attending for a year before matriculation in ED (if accepted).

I am currently a PGY2 FM resident. I graduate in July of 2019. During the last year and a half I have fallen in love with EM. I am planning on applying to EM residencies during the 2019-2020 ERAS cycle (matriculating June/July of 2020). I was not adequately exposed to EM during med school and did not consider it until my first EM rotation during residency. Out of all my rotations before and since, I've connected and resonated most with the pace, people and type of medicine practiced in EM. Besides the odd hours it truly is the "the most interesting 15 minutes of every other specialty" for me. I have rotated through just about every specialty and sub specialty at this point and by far, EM has been the most enjoyable, educational, inspirational and engaging rotation.

I understand that the specialty is far from perfect, has a high (highest?) burn out rate and the hours are tough. I know that reduced funding will be a very difficult, if not insurmountable, hurdle to overcome. I’ve had one PD look at my CV and say: “we would love to interview you but would not be able to take you on due to the funding deficiency”. A little discouraging; nevertheless, I intend to press on.

Brief summary of me “on paper”:
· DO
· No red flags, failures or bad reviews in med school or residency.
· MS I/II grades were all A's and B's with a couple C's (nephro and electrophys--I stink at math).
· MS III/IV all rotations were High Pass or Honors.
· COMLEX I, II, III: 547, 618, 655. No USMLE…(would it help if I take USMLE Step 2?)
· PGY1 In Training Exam was highest in class, well above national mean. PGY2 ITE was well above national mean, 2nd highest in class.
· I'm a Fulbright Fellow (like a Rhodes or Watson scholarship, with State Department), have a Masters in Middle East Studies and have a bunch of other "life-experiences” and extra curriculars like extensive medical missions, I’m a therapy dog trainer, former Israeli EMT, and other similar “soft points”.

My plan at this time (Please feel free to add/modify/correct/comment. I’ll be adjusting my plan and expectations as I proceed):

1. Call PDs of every EM program that has a DO in their residency class or core faculty and asking them the above question, reworded appropriately.

2. Apply to every viable EM program in the country based off their DO resident track record and my calls.

3. Schedule as many electives as possible in our ED. My hospital does not have an EM residency, unfortunately.

4. Keep grabbing shifts in the ED during my weekends/time off.

5. I start moonlighting in Urgent Care this July.

6. Get SLOEs from my EM attendings and EM director.

7. Work with my program to get funding for an away rotation at a viable EM residency ASAP. There is a 50/50 chance I will be unable to make that happen due to difficulty funding resident away rotations.

8. As a final option/resort: Contact the FM- EM Fellowship programs and see what the end results of their programs are (employment, locations, pay, etc).

9. Lastly, in case there was any confusion, I will definitely be completing my FM training.

Good plan? Any suggestions??

Thank you.

This is all wrong. Why aren't you switching into something where you won't work nights, weekends, holidays or take call, and you'll make lots of money?

That's the only rational choice.

 

[Odaleyguey11]

This is all wrong. Why aren't you switching into something where you won't work nights, weekends, holidays or take call, and you'll make lots of money?

That's the only rational choice.

I love the gallows humor here. My EM attending keeps a running game going of “what speciality should I have done instead”. Usually he lands on Derm. Are you all actually miserable and feel like you’re not living up to your potential? Or is this just dry, self-deprecation?

 

[Birdstrike]

I love the gallows humor here. My EM attending keeps a running game going of “what speciality should I have done instead”. Usually he lands on Derm. Are you all actually miserable and feel like you’re not living up to the “fantasy”? Or is this just dry self depricating joking?

I’m very happy.
I have a great life with no regrets.
And it wasn’t even one bit, a joke.

 

[Odaleyguey11]

I’m very happy.
I have a great life with no regrets.
And it wasn’t even one bit, a joke.

Thanks Birdstrike.

Just for clarification (I’m feeling slow after my 24h), you’re saying you love EM, have zero regrets but think I’m wrong in wanting to do a second residency in EM (after finishing FM) based on the fact that I will be working nights, weekends, holidays, etc? The aspects of your reply that threw me off were about taking call and earnings: My experience is that EM docs don’t take call and make a very good living. Have I misunderstood your comments?

I still hold fast to the belief that I am what I’m willing to suffer for (at least in part). I’m willing to retrain in EM (after FM) and suffer loss of time, money, normal life and maybe some health in order to pursue this passion—even if after 5-10 years it just becomes a job I enjoy most of the time rather than my all-encompassing, self defining purpose in life. I’m under no illusion that at the end of the day, it’s still a job. My goal is to enjoy what I do approximately 70% of the time.

My second option is an FM hospitalist fellowship. I enjoy Hospital medicine on the more acute and complex floors like the step down units. It would increase my marketability and give me 9 months on the floors/admissions/ICU cross coverage and 3 dedicated months in the ICU—good for job search, safer for patients.

 

[BoardingDoc]

Thanks Birdstrike....

you’re saying you love EM, have zero regrets ... Have I misunderstood your comments?

Yes, you have. Birdstrike doesn't do EM anymore and certainly doesn't have any regrets ... about leaving EM to do pain.

 

[Odaleyguey11]

Oh! Gotcha! Thanks for clearing that up. Interventional pain medicine is awesome!
So, asking you attendings and residents... do you think I’m being unreasonable and naive about wanting to go in EM training after FM if given the chance?

 

[enalli]

Like Birdstrike said, there are some negatives to EM that aren't fully apparent until you start doing it full time. EM isn't for everyone, but it is for a lot of people. If you 100% know that it is for you, then do it. If you aren't 100%, then perhaps consider working in an ER for a year and then deciding. Best case scenario, you can tell PDs that you loved it and want to be well-trained in it; worst-case scenario, you hate it but made a year of attending salary.

 

[Birdstrike]

Thanks Birdstrike.

Just for clarification (I’m feeling slow after my 24h), you’re saying you love EM, have zero regrets but think I’m wrong in wanting to do a second residency in EM (after finishing FM) based on the fact that I will be working nights, weekends, holidays, etc? The aspects of your reply that threw me off were about taking call and earnings: My experience is that EM docs don’t take call and make a very good living. Have I misunderstood your comments?

I still hold fast to the belief that I am what I’m willing to suffer for (at least in part). I’m willing to retrain in EM (after FM) and suffer loss of time, money, normal life and maybe some health in order to pursue this passion—even if after 5-10 years it just becomes a job I enjoy most of the time rather than my all-encompassing, self defining purpose in life. I’m under no illusion that at the end of the day, it’s still a job. My goal is to enjoy what I do approximately 70% of the time.

My second option is an FM hospitalist fellowship. I enjoy Hospital medicine on the more acute and complex floors like the step down units. It would increase my marketability and give me 9 months on the floors/admissions/ICU cross coverage and 3 dedicated months in the ICU—good for job search, safer for patients.

For one, don't let anything I, or anyone else says on the internet, keep you from chasing your "passions," whatever they may be, EM included. Do what's right for you, for your own reasons. What I say, doesn't matter. Only you have to live with their consequences, not us. That being said, I'll answer your questions.

There are certain things, I love about EM. I love suturing people at 2 pm on Tuesdays. I love the ortho stuff. I love treating treatable infections. I love treating actual emergencies I can help. As much as I enjoy doing that kind of work, I don't love doing it at 4:57 in the morning, and I don't love doing it, if it means I'm miserable from chronic shift-work sleep-dysphoria even on my day shifts and days off. It's something that no matter how hard I tried, I just couldn't shake. In other words, I don't love the lifestyle as I experienced it. The lifestyle, became life toxic after a while, for me. Only me. I'm not speaking about the specialty, or anyone else. Just me. EM was great for me, for a while. I don't regret going into it, and wouldn't change my experience for the world. I just wasn't meant to work ED shifts until I was 60.

Although the lifestyle looked good on paper, and in my head, when I was 26, single and I saw myself as indestructible, it ended up having a shelf life of about 5 years, for me. Once marriage and family came along, I felt burnout coming, and coming fast. The lifestyle no longer was a "life style." It became a hangover. I wasn't quite at maximum burnout yet, but I knew it was coming and coming fast. Granted, the jobs I worked out of residency were tough ones, always a doc or two short, always cattle prodding about metrics, and always pushing, pushing us to work more shifts, longer shifts, faster and with ever increasing unrealistic expectations. And maybe if I had hopped from job to job, I would have found one that didn't try to make me solve the national Emergency Department overcrowding crisis each shift myself. But I decided not to play that game; always moving, looking, searching for the perfect job, when it really was working the nights, weekends and holidays that tortured me, due to the hangover effect it produced in my mental state (chronic jet-lagged feeling; shift-work sleep-dysphoria). I eventually came to the conclusion that I'd do anything, ANY, type of work, even laying brick if that's what it meant, if I could maintain my salary (approximately) and ALSO have a normal life. A normal life.

A NORMAL LIFE.

It had been decades, since I had a normal life and had any sense of feeling persistently well rested, before residency, medical school, call and even pre-med when I work jobs to pay some bills other people didn't have. I decided I wanted to sleep at night, and be awake during the day. That's it. It's as simple as that. Predictability. R.E.M. sleep. Knowing when I was going to work

I didn't want every "day off" contaminated with circadian rhythym dysphoria from whatever bats**t crazy hours I had worked the day before, leaving me jet lagged feeling only to have some administrator beat me over the forehead over why I didn't see a URI fast enough at 4 am, because I need 30 seconds to get a gatorade and pop tart in place of a real meal while shaking off the emotional destruction of a hopeless, unexpected and soul crushing peds death, the likes of which he'll never, ever, ever understand having to be responsible for taking care of. Simply, I committed myself to doing whatever I had to do, to have a normal life. If I even remotely thought there was even a 1 in a hundred chance I could find a way to work 7 am - 3 pm, Mon - Friday, and still work EM shifts, I would have done it. But it doesn't exist. If you want to do EM, you have to buy in, totally and completely, to having a weird, weird, weird, schedule that haunts your "days off" which aren't really days off. Forever. No amount of "days off" can guarantee to make up for it, and no ED director can ever guarantee you they won't need you more, if someone quits, volume increases, or some administrator simply decides he wants you to work 25% harder/faster/more.

So, I no longer work general EM shifts. I left general EM about 7 years ago to do an Interventional Pain fellowship. And it's worked out for me great. I get to sleep at night, I see sunlight when I'm awake, I have 10 times the energy than I did in EM and 1,000 times more hope and optimism about everything. Maybe I just wasn't right for what I'll now call "general EM," since technically now I still work in EM, just a "subspecialty" of it. Or maybe I just had a shorter shelf life than the others. Or maybe the specialty needs to do a better job of ENFORCING wellness within the specialty, and develop real life changes that reduce burn out. Or maybe I'm just a p***y. I don't know. But I live a normal life now. And I'm happy. And my stress level is 90% less than it used to be. And I feel like I could do this until I'm 110, if I need to.

So, when I said that what you said in your post was "not rational," I should have specified that it wouldn't be rational, for me. Do what's best for you. If I had listened to everyone on this board that told me doing a Pain fellowship is "The worst thing imaginable! Oh, I'd HATE that!" then I wouldn't be in the much better, happier, rested, satisfied state I am today.

P.S. Pain Medicine is an official subspecialty of Family Medicine now, too. I'm not saying it's what you need to do, or that it would be the right career path for you, but it's likely something you haven't given much thought. But I found myself in a not too dissimilar place from yours. I could have thrown out my EM background, started over and retrained in Derm or something like that. That might have worked. But instead, I found this, which allowed me to build on my EM, while adding a fellowship. Rather than replacing my specialty, I simply added one. Before I was an EP trained to work in EDs. Then I became an EP trained to either work in EDs, in the Interventional Pain world, or both.

 

[Status Sciaticus]

For one, don't let anything I, or anyone else says on the internet, keep you from chasing your "passions," whatever they may be, EM included. Do what's right for you, for your own reasons. What I say, doesn't matter. Only you have to live with their consequences, not us. That being said, I'll answer your questions.

There are certain things, I love about EM. I love suturing people at 2 pm on Tuesdays. I love the ortho stuff. I love treating treatable infections. I love treating actual emergencies I can help. As much as I enjoy doing that kind of work, I don't love doing it at 4:57 in the morning, and I don't love doing it, if it means I'm miserable from chronic shift-work sleep-dysphoria even on my day shifts and days off. It's something that no matter how hard I tried, I just couldn't shake. In other words, I don't love the lifestyle as I experienced it. The lifestyle, became life toxic after a while, for me. Only me. I'm not speaking about the specialty, or anyone else. Just me. EM was great for me, for a while. I don't regret going into it, and wouldn't change my experience for the world. I just wasn't meant to work ED shifts until I was 60.

Although the lifestyle looked good on paper, and in my head, when I was 26, single and I saw myself as indestructible, it ended up having a shelf life of about 5 years, for me. Once marriage and family came along, I felt burnout coming, and coming fast. The lifestyle no longer was a "life style." It became a hangover. I wasn't quite at maximum burnout yet, but I knew it was coming and coming fast. Granted, the jobs I worked out of residency were tough ones, always a doc or two short, always cattle prodding about metrics, and always pushing, pushing us to work more shifts, longer shifts, faster and with ever increasing unrealistic expectations. And maybe if I had hopped from job to job, I would have found one that didn't try to make me solve the national Emergency Department overcrowding crisis each shift myself. But I decided not to play that game; always moving, looking, searching for the perfect job, when it really was working the nights, weekends and holidays that tortured me, due to the hangover effect it produced in my mental state (chronic jet-lagged feeling; shift-work sleep-dysphoria). I eventually came to the conclusion that I'd do anything, ANY, type of work, even laying brick if that's what it meant, if I could maintain my salary (approximately) and ALSO have a normal life. A normal life.

A NORMAL LIFE.

It had been decades, since I had a normal life and had any sense of feeling persistently well rested, before residency, medical school, call and even pre-med when I work jobs to pay some bills other people didn't have. I decided I wanted to sleep at night, and be awake during the day. That's it. It's as simple as that. Predictability. R.E.M. sleep. Knowing when I was going to work

I didn't want every "day off" contaminated with circadian rhythym dysphoria from whatever bats**t crazy hours I had worked the day before, leaving me jet lagged feeling only to have some administrator beat me over the forehead over why I didn't see a URI fast enough at 4 am, because I need 30 seconds to get a gatorade and pop tart in place of a real meal while shaking off the emotional destruction of a hopeless, unexpected and soul crushing peds death, the likes of which he'll never, ever, ever understand having to be responsible for taking care of. Simply, I committed myself to doing whatever I had to do, to have a normal life. If I even remotely thought there was even a 1 in a hundred chance I could find a way to work 7 am - 3 pm, Mon - Friday, and still work EM shifts, I would have done it. But it doesn't exist. If you want to do EM, you have to buy in, totally and completely, to having a weird, weird, weird, schedule that haunts your "days off" which aren't really days off. Forever. No amount of "days off" can guarantee to make up for it, and no ED director can ever guarantee you they won't need you more, if someone quits, volume increases, or some administrator simply decides he wants you to work 25% harder/faster/more.

So, I no longer work general EM shifts. I left general EM about 7 years ago to do an Interventional Pain fellowship. And it's worked out for me great. I get to sleep at night, I see sunlight when I'm awake, I have 10 times the energy than I did in EM and 1,000 times more hope and optimism about everything. Maybe I just wasn't right for what I'll now call "general EM," since technically now I still work in EM, just a "subspecialty" of it. Or maybe I just had a shorter shelf life than the others. Or maybe the specialty needs to do a better job of ENFORCING wellness within the specialty, and develop real life changes that reduce burn out. Or maybe I'm just a p***y. I don't know. But I live a normal life now. And I'm happy. And my stress level is 90% less than it used to be. And I feel like I could do this until I'm 110, if I need to.

So, when I said that what you said in your post was "not rational," I should have specified that it wouldn't be rational, for me. Do what's best for you. If I had listened to everyone on this board that told me doing a Pain fellowship is "The worst thing imaginable! Oh, I'd HATE that!" then I wouldn't be in the much better, happier, rested, satisfied state I am today.

P.S. Pain Medicine is an official subspecialty of Family Medicine now, too. I'm not saying it's what you need to do, or that it would be the right career path for you, but it's likely something you haven't given much thought. But I found myself in a not too dissimilar place from yours. I could have thrown out my EM background, started over and retrained in Derm or something like that. That might have worked. But instead, I found this, which allowed me to build on my EM, while adding a fellowship. Rather than replacing my specialty, I simply added one. Before I was an EP trained to work in EDs. Then I became an EP trained to either work in EDs, in the Interventional Pain world, or both.

Couldnt a lot of your problems with those overnight shifts/circadian rhythm issues be resolved by working for a group that has dedicated nocturnists? Had you considered other specialties that "maintained your salary and had a normal life" like anesthesia or rads?
Either way, Im glad you have a lot less stress in your life now!

 

[Birdstrike]

Couldnt a lot of your problems with those overnight shifts/circadian rhythm issues be resolved by working for a group that has dedicated nocturnists?

The job I spent the bulk of my time with did have dedicated nocturnists. I should say, they tried to have dedicated nocturnists. We'd get the nights covered for a while, which was great, but you still might have a random night or two to fill in a gap, here or there, which blows up your whole week. You'd also still have the 6 pm to 2 am or 6 pm to 4 am shifts which weren't considered "nights," but we all know, they really are. Then, enough time would go and a guy would leave and blow a hole in your nocturnist coverage for a while, and they'd jack your nights up again until you hired a replacement. This was really tough to deal, especially when unexpected and after a nice stretch of not having to do any nights. Or, after a while, a night guy would cry uncle and say he couldn't do it anymore, or the extra money wasn't worth it, or whatever, and then you're back to square one. I definitely think having dedicated nocturnists is an important adaptation that should probably be mandated, not just optional. But the classic EM strength of job mobility, can be a weakness at times if people are coming and going over time, and you're plan falls through.

Had you considered other specialties that "maintained your salary and had a normal life" like anesthesia or rads?

I considered other specialties while in Medical School, like everyone else, but when I was trying to make a change after the fact, I was nearing 40, married, with two kids (house, debt, etc) and had been out of residency long enough that going back for multiple years was just too much to justify. A one year fellowship therefore became a great option. You can do anything for one year. Well, almost anything.

Either way, Im glad you have a lot less stress in your life now!

Thanks.