Frazier

Palliative Emergentologist
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I am an EM-2 resident and will be applying for a palliative fellowship in the summer. The many insightful and inspiring posts you have shared on this forum had a lot to do with my decision to pursue HPM...so thank you again for that :)

This is very exciting news. Consider documenting your journey through applications/interviews/fellowship right here on this forum.

More data points and narratives for the field. I know I'd be interested in hearing about it -- so I'm sure many others would too!

Whether you decide to practice fulltime EM after fellowship (and use your palli skills), split practice, or full-time HPM (I hope you choose this option)... I'm confident you're going to come out ahead longterm in many many many ways.
 
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Frazier

Palliative Emergentologist
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Yeah, sounds better than a day in the life of an EM attending in 2021 for sure. Here is a question I thought of: is there any possibility of having an outpatient practice after fellowship? I gather that after palliative fellowship, you are most likely going to employed by a hospital, but I am just curious if other arrangements are possible/plausible. Hospital admin drives me a little crazy with their obsession over metrics, but then maybe that is more of an EM problem.

Great question. In one word: yes. [Of course, there is more to it, but: "yes".]

Depending on your neck of the woods, there will be different availability of palliative services already in place for hospitals/specialists (read: oncologists, cardiologists, pulmonologists, nephrologists, etc.). On the one hand, if you are in a location with a lot of robust health systems or one main health system (but all the docs in the community are owned by the health system), it will be pretty damn hard. And on the other hand, if you are in an underserved area and the hospital has no formal palliative program (or maybe just a doc/np that does inpatient goals of care discussions), it is wide open for driving your stake in the ground with a private practice.

When there is a lot of competition (first example), many of the patients who will benefit from your expertise are going to be funneled to the teams that already have done great by that Oncologist (or whoever). If the docs are all owned by the health system, they will likely not refer to an outsider (per se) easily.

All that said, if you mean that you want to work outpatient (employed) after fellowship -- then, yes, and quite easily. There are many postings and opportunities for outpatient/clinic positions. Nevertheless, as with all specialties, it just gets harder if you want to be independent.

If you are thinking concierge or cash-based practice, I would heavily lean toward "no" -- it likely will not go well.

There is more to it, but it depends a bit on which way you were thinking...
 
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Gotcha. That all makes a lot of sense and is encouraging. I was asking the question in a pretty vague sense really, what I was hoping to hear was simply that there existed some opportunities to have an employer besides the hospital. One of the lessons I've learned from being in EM is that its better to have options for what type of practice you can have.
 
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This is very exciting news. Consider documenting your journey through applications/interviews/fellowship right here on this forum.

More data points and narratives for the field. I know I'd be interested in hearing about it -- so I'm sure many others would too!

Whether you decide to practice fulltime EM after fellowship (and use your palli skills), split practice, or full-time HPM (I hope you choose this option)... I'm confident you're going to come out ahead longterm in many many many ways.
Will do!! Thank you :)
 
Aug 20, 2019
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This is very exciting news. Consider documenting your journey through applications/interviews/fellowship right here on this forum.

More data points and narratives for the field. I know I'd be interested in hearing about it -- so I'm sure many others would too!

Whether you decide to practice fulltime EM after fellowship (and use your palli skills), split practice, or full-time HPM (I hope you choose this option)... I'm confident you're going to come out ahead longterm in many many many ways.
I am thinking I will likely will go the route of full-time HPM. Will you also be going this route as well? If so, I'm curious to hear more of your thoughts about going this path vs split practice vs full-time EM (with incorporation of HPM).

Thank you :)
 

Frazier

Palliative Emergentologist
10+ Year Member
Nov 12, 2009
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Gotcha. That all makes a lot of sense and is encouraging. I was asking the question in a pretty vague sense really, what I was hoping to hear was simply that there existed some opportunities to have an employer besides the hospital. One of the lessons I've learned from being in EM is that its better to have options for what type of practice you can have.

Sure thing! While hospitals are likely the largest employer of palliative docs, freestanding cancer, and specialty practices also serve as employers across the country. For hospice, you have both nonprofit and for-profit agencies, large corporations, and tiny mom-and-pop shops. As I noted earlier, there are independent practices (granted rarer) -- or you could set up your own shop depending on the market and your energy/risk tolerance.
 

Frazier

Palliative Emergentologist
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Nov 12, 2009
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I am thinking I will likely will go the route of full-time HPM. Will you also be going this route as well? If so, I'm curious to hear more of your thoughts about going this path vs split practice vs full-time EM (with incorporation of HPM).

Thank you :)

I am taking a full-time palliative position, you got it.

In my opinion, the driver needs to be the individual's goals and interests. Pretty much my only satisfaction from working in the ED at this point is doing palliative medicine. So then the question arises -- if that is what I enjoy doing, why not just do it exclusively?

It took some time for me to be okay with leaving the ED. But after talking with colleagues who have been in the same/similar scenario and thinking it over myself, I've come to terms with it.

Cardiologists and gastroenterologists do not practice as their primary specialty, they don't try to search out a 50/50 split internist/cardiology job. It took some time for me to lose the guilt and appreciate that there is no reason to feel another way just because my primary specialty is EM instead of IM. I don't have to abandon that foundation, my EM knowledge and understanding will stick with me -- the skills, efficiency, and heuristics will ultimately rust.

I am however going to maintain a relationship with the ED in the form of being the liaison between our departments RE: protocols and policies to help bridge the services as smoothly as possible for our patients.

I do appreciate that the above is not for everyone. Some people take strong passion in the practice of emergency medicine -- for those people, it makes perfect sense to try to continue to implement it into their career part-time. That said, those opportunities exist. I came across multiple positions that were amenable to splitting time between HPM and EM.

For the true "100% EM forever doc" who wants to take their game to the next level and wants/needs to do a fellowship for XYZ reason, then an HPM fellowship makes a great option for adding specific tools to the toolbox that otherwise would not exist -- or at least not be as sharp.

It really depends on the person.
 
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