EM Residency and FM private practice

[wishuponastar]

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Can you do a residency in emergency medicine and then work in an emergency room while having a separate private family practice at the same time? Not in the sense that it is impossible hours wise but I guess what I am asking is do you have to do two separate residencies or are you able to practice family medicine with your EM res.? Also, what is the difference between internal medicine and family medicine? What is internal medicine?

 

[deleted87716]

Technically, you don't need to complete any kind of residency in order to work in an ED or an ambulatory clinic, unless it's required by your employer.

That being said, most hospitals these days require their ED physicians to be BC/BE in EM, although it's possible to find jobs in less urban/suburban areas where this isn't yet a requirement.

As for working in an ED as well as an outpatient clinic, sure...it's possible. However, IMO, EM residency doesn't really prepare you well for primary care, and FM residency doesn't really prepare you well for EM. FM residents can do a fellowship in EM (click here for a list of FM fellowships). There's also one dual FM/EM residency in the works at Christiana Care in Wilmington, DE. Depending on one's individual interests and aptitude, however, it's certainly possible to acquire sufficient skills and experience to enable you to practice competently in the ED as well as in an ambulatory setting.

Many EM physicians work in urgent care, which is sort of "EM Lite." It's basically primary care without an appointment. 😉

Your questions regarding IM vs. FM may be answered in the Family Medicine FAQ on the FM Forum.

 

[EctopicFetus]

Technically you can hang a shingle and practice "General" Medicine after 1 yr of residency. Prior to finishing 1 yr of residency you can not practice medicine without supervision (aka residency). Truth is I dont think there is a ton of overlap.

As Kent said EM residency def doesnt prepare you for FM and I doubt FM residency preps you for EM. I dont think you see/treat very ill pts as a true FM doc. In EM you better know how to tube someone, start very invasive lines, and take care of super sick trauma/medical patients. This is something most FM docs dont do on a daily basis.

There is a long laundry list of things FMs do that EM docs dont as well but ill let someone else expand on that!

 

[AmoryBlaine]

A general comment:

Speaking to younger medical students I often hear questions about combined residencies. I have heard several people say they planned to do EM/IM and see their own f/u in clinic 2-3 days a week. Other people plan on trying to combine other residencies and basically practice two forms of medicine.

Except for Med/Peds this really doesn't happen. My sense would be if you didn't count Med/Peds than less than 1% of docs would be BC/BE in multiple specialties. You pretty much pick one thing and go with that.

 

[angel80]

As far as what Internal Medicine is and what is the difference between IM and FP, here is the scoop.

Internal Medicine deals with the diagnosis and nonsurgical treatment of diseases affecting adults. IM also deals with prevention of disease as well. After completing a residency, one can work as a general internist (either practicing outpatient medicine, hospitalist medicine, or both), or can go for fellowship in one of the IM subspecialties (Cardiology, Nephrology, GI, Endocrinology, Pulmonary/Critical Care, etc). IM residency consists of doing general IM (predominantly inpatient, but with some outpatient experience as well) and rotating through the various subspecialties.

Family Practice, on the other hand, doesn't just deal with adults. FP involves treating adults, children, and can involve some Ob/Gyn and Surgery as well. In general, FP residency had a lot more outpatient traing that IM. Also, FP residency involves rotating through Peds, Ob/Gyn. Surgery, etc, but doesn't involve as much subspecialty training (it would be impossible to rotate through all of the IM, Peds, and ob/gyn subspecialities in 3 years). FP does have a few fellowship of its own as well, but in general, most people go into primary care.

 

[docB]

Can you do a residency in emergency medicine and then work in an emergency room while having a separate private family practice at the same time?

An EM residency will not prepare you to be a primary care doc. You will have little to no training in the most basic primary care issues such as ongoing management of chronic diseases (COPD, HTN, DM). If you do an EM residency plan on working in an ED or an urgent care center. If you do an IM, FP residency plan on working in a clinic.

 

[mikecwru]

An EM residency will not prepare you to be a primary care doc. You will have little to no training in the most basic primary care issues such as ongoing management of chronic diseases (COPD, HTN, DM). If you do an EM residency plan on working in an ED or an urgent care center. If you do an IM, FP residency plan on working in a clinic.

You said in a much nicer way my answer: **** or get off the pot.

mike

 

[sophiejane]

I dont think you see/treat very ill pts as a true FM doc.

Many don't, but some certainly do. Some FM docs manage their patients in the hospital, including the ICU. Particularly in rural areas, FM docs frequently staff the ER and do intubations, chest tubes, etc.

 

[lowbudget]

I dont think you see/treat very ill pts as a true FM doc. In EM you better know how to tube someone, start very invasive lines, and take care of super sick trauma/medical patients. This is something most FM docs dont do on a daily basis.

Many don't, but some certainly do. Some FM docs manage their patients in the hospital, including the ICU. Particularly in rural areas, FM docs frequently staff the ER.

http://www.aafp.org/online/en/home/aboutus/specialty/facts.html

Table 59 (a, b, c, d) breaks down what FPs do with Table 60 (a, b, c, d) looking at urban versus rural. Tables 31-58 has details by patient care.

For example of FPs surveyed in 2005
54.2% do EM work (48.8% urban, 71.8% rural)
48.2% do ICU work (42% urban, 66.8% rural)

Compare that against
24% who do Routine Deliveries
4.4% who do C-Sections
1.9% who do Major Surgery
66.4% who do Newborn care

So while the "majority" (51%) of urban FPs don't do EM or ICU work (or "see/treat very ill patients") a large amount do, contrary to popular belief. And contrary to popular belief that "a lot" of FPs do C-sections and even do appendectomy/hernias/gallbladder, few do.

These numbers don't show how sick patients are, how many lines/tubes were done. They also don't tell you whether or not FPs are adequately trained to be in the ED. I'll leave that pissing contest to others who know more than me.

 

[EctopicFetus]

http://www.aafp.org/online/en/home/aboutus/specialty/facts.html

Table 59 (a, b, c, d) breaks down what FPs do with Table 60 (a, b, c, d) looking at urban versus rural. Tables 31-58 has details by patient care.

For example of FPs surveyed in 2005
54.2% do EM work (48.8% urban, 71.8% rural)
48.2% do ICU work (42% urban, 66.8% rural)

Compare that against
24% who do Routine Deliveries
4.4% who do C-Sections
1.9% who do Major Surgery
66.4% who do Newborn care

So while the "majority" (51%) of urban FPs don't do EM or ICU work (or "see/treat very ill patients") a large amount do, contrary to popular belief. And contrary to popular belief that "a lot" of FPs do C-sections and even do appendectomy/hernias/gallbladder, few do.

These numbers don't show how sick patients are, how many lines/tubes were done. They also don't tell you whether or not FPs are adequately trained to be in the ED. I'll leave that pissing contest to others who know more than me.

one thing to consider about Em and FPs practicing Em is that EM is relatively new and fewer and fewer places are hiring FPs I would guess many of those who state they practice Em are either grandfathered in or are doign urgent care. Not a pissing contest. I think FPs are great but the real overlap of the 2 fields is minimal.