EM Residency Lengths

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Ninjawiz500

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Hey,

I am going to start M1 in the US this year and I am fairly interested in EM at this point. Post-residency, I would like to be able to work in overseas countries for some period of time (mainly Commonwealth countries, ie. NZ, Australia, Canada, etc.) which typically have 5 year EM training. Does anyone know if it is reasonable to apply only to 4 year EM residencies (ie. Are there a reasonable number of not insanely competitive options), or to spend an extra year in a 3 year program somehow?

Thanks for the help.
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this website has come good information: Where Can American Doctors Practice Abroad?

I don't think you necessarily need to do 5 years training.

If after doing more research you feel you need to, you could do a fellowship, 3+2 or 4+1 and most countries would consider that "5 years"
 
It is very difficult to compare training here with countries outside the Untied States.

What they would consider "EM training" may very well here be the MS III/IV years plus three years of EM residency.

How we classify the years of medical education is very different from the UK and the countries that follow that model.

I don't think I every figured out an exact correspondence with British medical education, and the only conclusion I came to was don't even try.
 
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Ninjawiz500 said:
Hey,

I am going to start M1 in the US this year and I am fairly interested in EM at this point. Post-residency, I would like to be able to work in overseas countries for some period of time (mainly Commonwealth countries, ie. NZ, Australia, Canada, etc.) which typically have 5 year EM training. Does anyone know if it is reasonable to apply only to 4 year EM residencies (ie. Are there a reasonable number of not insanely competitive options), or to spend an extra year in a 3 year program somehow?

Thanks for the help.
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Are you independently wealthy or is someone footing your medical school/residency bill? If not, I'd focus on stomping out that debt as quickly as possible once you finish residency instead of picking the lower paying jobs abroad. That being said, judging from your past posts, it appears that you are Australian, so I can understand wanting to move closer to home. That being said...it would be nice to stay in the U.S. for a few years and give back (making more $$$ in the process) considering that U.S. tax payers paid for all your GME funding during your training. That's one thing that aggravates me about foreign citizens jumping ship from the U.S. directly following residency training. It's a real disservice to the citizens of this country who essentially helped train you out of their pockets and get nothing in return if you decide to leave immediately following residency. No offense.

As to practicing in NZ or Australia. Honestly...you should probably know more about that process than any of us. The last I looked into it...I think there was a 1-2 year period where you have to technically work under another EM physician until you have 5 years or something like that but don't quote me. Strange that you want to complete EM in the U.S. if your ultimate goal is to get back home to practice? Seems like an uphill route.
 
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Canada: GLHF

Aus/NZ: Should be able to get a job in a "fellow" role somewhere after completion of U.S. EM residency. Then you can start trudging down the SIMG pathway with ACEM and determine the requirement for additional supervised practice to be judged "equivalent".

Of course, this could all be different by the time you finish school, so, :shrugs:
 
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Apollyon said:
"Good luck, have fun". It's akin to "AMF, YOYO" or "Go with God".
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Thanks.

Is it just me, or does Canada seem especially unreasonable when it comes to training equivalency; considering their dearth of medical schools and "brain drain" to the US?
 
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RustedFox said:
Thanks.

Is it just me, or does Canada seem especially unreasonable when it comes to training equivalency; considering their dearth of medical schools and "brain drain" to the US?
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Seeing as Canadian residents not infrequently come to the US to do away rotations where they're taught by US BCEP's...yes.
 
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Angry Birds said:
How on earth are we supposed to know these acronyms? I feel like you’re making them up.
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Definitely not made up. I got "good luck" but missed the HF in "GLHF".

Eh; don't feel too badly - its like you just "didn't see that one movie that everyone else raves about". Everyone has a movie or show like that.

Full disclosure, I didn't understand the term "spongeworthy" until recently when I read about it online, as I never really watched "Seinfeld" hardly at all. I honestly thought it was about being a lazy cleaner and leaving a stain on a dish or appliance be because it "wasn't worth the effort to clean".
 
Groove said:
Are you independently wealthy or is someone footing your medical school/residency bill? If not, I'd focus on stomping out that debt as quickly as possible once you finish residency instead of picking the lower paying jobs abroad. That being said, judging from your past posts, it appears that you are Australian, so I can understand wanting to move closer to home. That being said...it would be nice to stay in the U.S. for a few years and give back (making more $$$ in the process) considering that U.S. tax payers paid for all your GME funding during your training. That's one thing that aggravates me about foreign citizens jumping ship from the U.S. directly following residency training. It's a real disservice to the citizens of this country who essentially helped train you out of their pockets and get nothing in return if you decide to leave immediately following residency. No offense.

As to practicing in NZ or Australia. Honestly...you should probably know more about that process than any of us. The last I looked into it...I think there was a 1-2 year period where you have to technically work under another EM physician until you have 5 years or something like that but don't quote me. Strange that you want to complete EM in the U.S. if your ultimate goal is to get back home to practice? Seems like an uphill route.
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Thanks for that! I am definitely considering staying and gaining experience in the US if visas permit, rather than leaving directly following residency training-otherwise, as you mentioned, it wouldn't really make sense for me to complete EM in the US in the first place. I was referring mainly to more long-term options as I am not a US citizen and therefore do not want to bank on being able to stay/work in the US indefinitely. Strangely enough, the J-1 visa most non-US students use for residency training has a home country residency requirement-it seems Uncle Sam isn't really interested in our return-of-service :confused:. Anyways, thanks for those insights, I will look into it further.
 
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Groove said:
That being said...it would be nice to stay in the U.S. for a few years and give back (making more $$$ in the process) considering that U.S. tax payers paid for all your GME funding during your training. That's one thing that aggravates me about foreign citizens jumping ship from the U.S. directly following residency training. It's a real disservice to the citizens of this country who essentially helped train you out of their pockets and get nothing in return if you decide to leave immediately following residency. No offense.
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1) Many US residency spots are not funded by Medicare.
2) US taxpayers extract plenty of value out of residency alone.
3) We have an emergency physician surplus.
 
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RadsWFA1900 said:
www.levernews.com

Private Equity Gloats Over A Doctor Glut

Health care vultures helped create an oversupply of ER physicians — now they want to use the surplus to cut wages and limit care.
www.levernews.com www.levernews.com

Talk about value extraction
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Every college student considering medicine as a career and every medical student considering specializing in EM should read this article.
 
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RadsWFA1900 said:
www.levernews.com

Private Equity Gloats Over A Doctor Glut

Health care vultures helped create an oversupply of ER physicians — now they want to use the surplus to cut wages and limit care.
www.levernews.com www.levernews.com

Talk about value extraction
Click to expand...

This article is so damn disgusting. I f'ing hate it. Here we are slaving taking care of patients, taking all the risk, and private equity takes our money with 1/1000 of the risk.
 
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Was gonna make a topic with that link but just noticed it was here.

We all know that's what PE is thinking but to my knowledge it's the first time any large group has publicly celebrated our demise in the name of profits.

Too many years of "the sky is falling" attitude (these posts are visible from archives from early 2000's and unrelated to PE) have numbed people to ignore them, but thats def a sky is falling article.
 
Wow, what gall. Such bald-faced greed.

Does this make anyone rethink the idea that market based capitalism is the best economic model for health care?
 
WilcoWorld said:
Wow, what gall. Such bald-faced greed.

Does this make anyone rethink the idea that market based capitalism is the best economic model for health care?
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No because it’s that old adage meet the new boss same as the old boss situation.
 
AlmostAnMD said:
Was gonna make a topic with that link but just noticed it was here.

We all know that's what PE is thinking but to my knowledge it's the first time any large group has publicly celebrated our demise in the name of profits.

Too many years of "the sky is falling" attitude (these posts are visible from archives from early 2000's and unrelated to PE) have numbed people to ignore them, but thats def a sky is falling article.
Click to expand...

In the story of “the boy who cried wolf”, the wolf eventually did show up.
 
  • Hmm
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DeadCactus said:
1) Many US residency spots are not funded by Medicare.
2) US taxpayers extract plenty of value out of residency alone.
3) We have an emergency physician surplus.
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The majority of residency programs ARE funded by Medicare. This costs well over 10 billion dollars a year of tax payer money. I would argue that most US taxpayers don't feel like they're extracting much of anything when they see a resident in the ED, especially PGY 1,2 who is being closely monitored/managed by his/her attending. It definitely doesn't lower their bill, that's for sure. If anyone is benefitting the most, it's the hospital. The majority of those "free labor" cost savings are only trickling down far enough to make it into the hospital exec's piggy bank and in no way reach the patient.

So, we've got a physician surplus. Instead of not paying them, you want to pay them to leave as soon as possible once they use up all your money for training? Sounds like a physician type of agricultural adjustment act from the 1930s.
 
Groove said:
The majority of residency programs ARE funded by Medicare. This costs well over 10 billion dollars a year of tax payer money. I would argue that most US taxpayers don't feel like they're extracting much of anything when they see a resident in the ED, especially PGY 1,2 who is being closely monitored/managed by his/her attending. It definitely doesn't lower their bill, that's for sure. If anyone is benefitting the most, it's the hospital. The majority of those "free labor" cost savings are only trickling down far enough to make it into the hospital exec's piggy bank and in no way reach the patient.

So, we've got a physician surplus. Instead of not paying them, you want to pay them to leave as soon as possible once they use up all your money for training? Sounds like a physician type of agricultural adjustment act from the 1930s.
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I agree with your wider point, but residents definitely significantly increase the number of patients that can be seen in the ED. If an academic attending is supervising a PGY1, two PGY2s, and a PGY3 in a shift, that's around 7 patients per hour getting seen on shift. There's no way an attending alone comes close to touching that, especially at places with any significant acuity.
 
Franzd'Epinay said:
I agree with your wider point, but residents definitely significantly increase the number of patients that can be seen in the ED. If an academic attending is supervising a PGY1, two PGY2s, and a PGY3 in a shift, that's around 7 patients per hour getting seen on shift. There's no way an attending alone comes close to touching that, especially at places with any significant acuity.
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I'm an academic attending and I find just the opposite. It's not a slam on residents by any means, I love working with them, I just think its really difficult in any stage of residency to gain the needed experience to function as a diagnostically accurate (and safe) minimalist. More often than not when I'm supervising residents...I notice labs, imaging or other testing that's not really needed to disposition the pt. I try not to micromanage because residency is all about learning but let's face it, if you picked 10 attendings 10 years out of residency versus 10 PGY2 or 3's, chances are the LOS is way better in the seasoned crowd. Now, if you're a maximalist and do lots of work ups then sure, residents might speed things up I suppose. I'm a pretty severe minimalist though. Differing opinions aside, it really doesn't get back to the root issue...cost savings to the pt. Let's say you're right and residents speed up the process, what's the pt's benefit then exactly? Decreased LOS in the ED? I doubt that translates to any savings when they get the check. Certainly nothing very tangible for their tax contributions. Again, the main person benefitting here is the hospital, not the pt. All the hospital has to do is feed the residents a free sandwich and Sprite Zero from the physician lounge in exchange for minimum wage labor.

You seriously see 7pph? How do you even find time to see the pt's much less lay hands on them? Way too fast/unsafe for me. I don't even know what my attest would look like: "Ran by the pt room and am pretty sure I saw the resident talking to them. I was present during the key portions of any procedures performed by the resident.....IN SPIRIT!"
 
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Groove said:
I'm an academic attending and I find just the opposite. It's not a slam on residents by any means, I love working with them, I just think its really difficult in any stage of residency to gain the needed experience to function as a diagnostically accurate (and safe) minimalist. More often than not when I'm supervising residents...I notice labs, imaging or other testing that's not really needed to disposition the pt. I try not to micromanage because residency is all about learning but let's face it, if you picked 10 attendings 10 years out of residency versus 10 PGY2 or 3's, chances are the LOS is way better in the seasoned crowd. Now, if you're a maximalist and do lots of work ups then sure, residents might speed things up I suppose. I'm a pretty severe minimalist though. Differing opinions aside, it really doesn't get back to the root issue...cost savings to the pt. Let's say you're right and residents speed up the process, what's the pt's benefit then exactly? Decreased LOS in the ED? I doubt that translates to any savings when they get the check. Certainly nothing very tangible for their tax contributions. Again, the main person benefitting here is the hospital, not the pt. All the hospital has to do is feed the residents a free sandwich and Sprite Zero from the physician lounge in exchange for minimum wage labor.

You seriously see 7pph? How do you even find time to see the pt's much less lay hands on them? Way too fast/unsafe for me. I don't even know what my attest would look like: "Ran by the pt room and am pretty sure I saw the resident talking to them. I was present during the key portions of any procedures performed by the resident.....IN SPIRIT!"
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Maybe my residency experience was an anomaly (I didn't think it was), but usually an attending would supervise 3-5 residents at a time. A typical breakdown would be 1 PGY1, 2 PGY2s, and a PGY3. 7 pph comes from the following estimate: 1.5 pph (PGY1) + 1.75 pph (PGY2) + 1.75 pph (PGY2) + 2 pph (PGY3).

I think if the staffing was 1 attending to 1-2 trainees, then you may be correct in that residents might be slowing the attending down. Once you get to 3+ trainees per attending, though, it's impossible for someone to see the equivalent number of patients without residents.

In any case, I do think it is right people who do their residency in the US to practice for a significant amount of time in the US, but I also do think they do provide value to US healthcare during training. I really don't think most busy academic departments could function without them.
 
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Franzd'Epinay said:
Maybe my residency experience was an anomaly (I didn't think it was), but usually an attending would supervise 3-5 residents at a time. A typical breakdown would be 1 PGY1, 2 PGY2s, and a PGY3. 7 pph comes from the following estimate: 1.5 pph (PGY1) + 1.75 pph (PGY2) + 1.75 pph (PGY2) + 2 pph (PGY3).

I think if the staffing was 1 attending to 1-2 trainees, then you may be correct in that residents might be slowing the attending down. Once you get to 3+ trainees per attending, though, it's impossible for someone to see the equivalent number of patients without residents.

In any case, I do think it is right people who do their residency in the US to practice for a significant amount of time in the US, but I also do think they do provide value to US healthcare during training. I really don't think most busy academic departments could function without them.
Click to expand...
I think you're overestimating how many patients can be seen by residents per hour. I sometimes supervise 3-5 residents at a time and have never ever come close to 7 patients/hr and hope I never do.
 
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carbonizedeyesockets said:
I think you're overestimating how many patients can be seen by residents per hour. I sometimes supervise 3-5 residents at a time and have never ever come close to 7 patients/hr and hope I never do.
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But are you at a Powerhouse Program™?

(You're probably right. It's been a while since residency.)
 
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I’m faculty at a Non-Powerhouse Program™ and the faculty group saw an average of 2.8pph last year (all seen initially by a resident or APP).

I do think we can see slightly more patients safely because the residents shorten the amount of time I spend documenting and potentially gaining some of the history, but it’s not 7pph or whatever was postulated above. The academic environment probably adds 0.5-0.75pph to my productivity when you factor in the type of acuity we see.
 
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CliveStaples said:
I’m faculty at a Non-Powerhouse Program™ and the faculty group saw an average of 2.8pph last year (all seen initially by a resident or APP).

I do think we can see slightly more patients safely because the residents shorten the amount of time I spend documenting and potentially gaining some of the history, but it’s not 7pph or whatever was postulated above. The academic environment probably adds 0.5-0.75pph to my productivity when you factor in the type of acuity we see.
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My academic years are behind me. I do not miss my residents having to shop their patients to multiple services trying to get them admitted.
 
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