EM residents: Community vs Academics

[beyond all hope]

Here's a poll for you.

Of the EM residents, which ones are thinking about academics and which ones want to do community medicine?

Of the EM attendings, how many are academic or community, and how did you end up where you are? Was that your first choice?

As with most people, I'd like to work in a democratic group that staffs both academic and community EDs. How many of those exist?

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[Andy Kahn]

Here's a poll for you.

Of the EM residents, which ones are thinking about academics and which ones want to do community medicine?

Of the EM attendings, how many are academic or community, and how did you end up where you are? Was that your first choice?

As with most people, I'd like to work in a democratic group that staffs both academic and community EDs. How many of those exist?

I definitely would love to do both academics and community. At Parkland, we have some faculty that also work at various community hospitals (Presbyterian Hospital of Dallas, Methodist Hospital of Dallas, Centennial in Frisco, Doctors Hopsital).

 

[FoughtFyr]

All academics and EMS here!

- H

 

[deleted52758]

this may be a dumb question, but what are county programs? are they considered community or academic...

or even dumber... what is the definition of an academic hospital? those affiliated with a major university or those with an affiliated residency?

 

[Apollyon]

this may be a dumb question, but what are county programs? are they considered community or academic...

or even dumber... what is the definition of an academic hospital? those affiliated with a major university or those with an affiliated residency?

County hospitals are those owned and run by municipalities as public-health ventures - primarily to deal with those who cannot provide for themselves, or do not have insurance. They can be community or academic.

An academic ED has residents (usually EM) rotating through it (a "signifigant number"), who provide most of the primary patient care. Community ED's primarily have attendings seeing patients as primary providers - there may be one resident per shift rotating through to get a "community hospital" experience (so it is still a community ED - the resident rotating doesn't make it academic), or IM, FP, or surgery residents rotating through to make their residency requirement.

An academic hospital is one that provides physician or other health provider education. These can be a university hospital, or one affiliated with a major university, or not affiliated (stand-alone, or community). However, a hospital can be affiliated with a university (even a major affiliation), but still be a community hospital. At the same time, there can be community programs in the hospital, side-by-side with University programs from the main university - one example I know of is the Long Island College Hospital in Brooklyn, which has community IM, Peds, diagnostic radiology, and Ob/Gyn programs (among others), but university anesthesia, surgery, and surgical subspecialties from SUNY-Downstate. Notably, this is different for hospitals vs. ED's. One such notable place is the Carolinas Medical Center, in Charlotte, NC. It has a major affiliation with UNC-Chapel Hill, but most of its programs are in-house, with only a few affiliated with UNC-Chapel Hill (about 2 hours away).

What does it round out to? Community ED's don't have residencies (generally), BUT, community hospitals can have EM residencies, with the difference being trauma (and trauma center designation), not being a tertiary care center, and not having various services available (like 24-hour on-call PCI, or surgery services in-house). This does NOT mean that these residency-trained EP's are less - in fact, if they are going to work in community jobs, they know what to expect, and, regardless, EM training is pretty well equal across the board in the US (as ABEM and ACGME stats will support).

 

[docB]

Here's a poll for you.

Where's the poll?

Of the EM attendings, how many are academic or community, and how did you end up where you are? Was that your first choice?

Community. Show me the money.

As with most people, I'd like to work in a democratic group that staffs both academic and community EDs. How many of those exist?

Here in Vegas the same group staffs UMC which is the academic/trauma center and the CHW community hospitals. They're not democratic though. They're part of EPMG.

 

[roja]

I will ultimately go academics. I am considering doing a few years community to make some buck first, though.

 

[spyderdoc]

I will ultimately go academics. I am considering doing a few years community to make some buck first, though.

Be careful. It may be tough (but not impossible, or unheard of, of course) to go academic after doing community...Some academic programs may think that you will have lost your "academic skills" after being away from it for a while, so they may be reluctant to hire a doc from the community.

 

[Apollyon]

Be careful. It may be tough (but not impossible, or unheard of, of course) to go academic after doing community...Some academic programs may think that you will have lost your "academic skills" after being away from it for a while, so they may be reluctant to hire a doc from the community.

One of our attendings did community for 2 or 3 years, then came to us as an academic attending. He will be doing a fellowship in sports med in July. Independently, we as residents and his wife both said next thing will be being a resident again, then a student.

As I see from our program, one way to go back to academics from community is to go to a newer program, where they may be more lenient. Work your chops for a couple years, and you should be back in the hunt for an academic place you want. We had 2 of our attendings recruited away to be associate or assistant PDs.

 

[docB]

I think going into the community for a while will not hurt and might even help you to return to academics IF you are doing something of interest in academics like running an ED US training and QA program or a chest pain obs unit. If you're just working the pit like me then you're probably hosed.

 

[Andy Kahn]

We love our attendings who have come back from the community setting (or are currently doing both). I actually think it is good to have some faculty who can tell you how things are done differently in the private setting. I personally was thinking that I should go work in a community setting for a few years and then come back to work in the academic ED. I was also contemplating working in both settings right away, but didn't know if was better to do a few years committed to private EDs first.

-andy