emergency/family Practice

[han14tra]

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I want to complete residencies in both family practice and emergency medicine. I plan to return to a rural underserved area and I think that in many small towns FPs provide a lot of emergency care simply because access to ERs is limited. I'm from a town where the nearest hospital is about 1 hour away and there's no public transportation. Most elderly people can't get to the hospital and if I practiced in town, I would most likely be seen by people who really need emergency treatment. I don't intend to run an ER out of my family practice but since it takes an ambulance nearly 45 minutes to get where I intend to practice, I think ER training would be invaluable for me. Does anyone know anything about combined ER and FM practice? Is it possible to work a few days a week as a FP and then spend a few days a month as an ER physician?

 

[coffeebythelake]

I want to complete residencies in both family practice and emergency medicine. I plan to return to a rural underserved area and I think that in many small towns FPs provide a lot of emergency care simply because access to ERs is limited. I'm from a town where the nearest hospital is about 1 hour away and there's no public transportation. Most elderly people can't get to the hospital and if I practiced in town, I would most likely be seen by people who really need emergency treatment. I don't intend to run an ER out of my family practice but since it takes an ambulance nearly 45 minutes to get where I intend to practice, I think ER training would be invaluable for me. Does anyone know anything about combined ER and FM practice? Is it possible to work a few days a week as a FP and then spend a few days a month as an ER physician?

I imagine if you want to do this, you should do an ER residency first.

 

[PeepshowJohnny]

Many FP residencies do give you a fair deal of emergency medicine practice (at least the ones around here do.) Similarly, you'll pick up quite a bit of surgery, OB/GYN, and peds because you're the "do everything doctor". Residencies recognize that FP docs frequently run small town ED's and give you ample training in these areas.

And a quick peruse of the internet demonstrates some Family Medicine programs can give you a fellowship or certification after residency in further emergency training for just those purposes. I imagine if I dig deeper I could find some combined FP/EM programs to which you could apply.

Kudos to wanting to help an underserved area by the way.

 

[howelljolly]

There is currently only one FP/EM program -- Christiana in Delaware.

However as a board certified FP, you can get a job in an Emergency Dept. in some places. These places are few and far between, but tend to be in rural and underserved areas.

You also might be able to get a 1 year non-accredited fellowship in EM after board certification in FP. According to the AAFP website, they exist in WV, NC, AK, and TN. They are not accredited, therefore can not lead to board certification. They are really only intended to help underserved areas.

 

[ubcredfox]

Do they not have additional training specifically tailored for FP's in the US?

Up in the Great White North, there are programs where you do an additional year of residency training in FP in an "area of interest" such as ER, geriatrics or anesthesia. Those skills are then utilized in smaller community hospitals/remote areas. So, if you go remote, in 3 years you're pretty much the ER doc...

 

[howelljolly]

In the US, there are some fellowships that a FP can chose to do. Some are accredited (sports med, geriatrics); some are not (emergency med, travel med)

Besides that, Family Practice is set up such that if the FP does more than X amount of a certain procedure during residency... they can do that procedure in their practice as an FP (Obstetrics, colonoscopy, vasectomy)

 

[TRAMD]

You don't need a combined residency. If you ONLY want to do emergency or urgent care, either will work. If you want to do any office, peds or OB then do Family.

Many Family Medicine trained docs work solely in ERs and urgent care or add it to their regular practice to increase income.

 

[jbar]

You should see this discussion in the EM forum on working in EDs as a FP.

http://forums.studentdoctor.net/showthread.php?t=478430

 

[dr.smurf]

there are also 5 or 6 D.O. combined FM/EM programs out there as well. if you for sure thats the kind of practice you would like to have you may think about going to an FP program that is heavy into rural and emergency care. good luck

 

[docB]

You don't need a combined residency. If you ONLY want to do emergency or urgent care, either will work. If you want to do any office, peds or OB then do Family.

Many Family Medicine trained docs work solely in ERs and urgent care or add it to their regular practice to increase income.

I would advise against doing an FP residency if you plan to work in an ED or do urgent care. There are FP trained docs who work in rural EDs that cannot attract or afford board certified EPs but this is the exception to the national trend.

 

[docB]

I want to complete residencies in both family practice and emergency medicine. I plan to return to a rural underserved area and I think that in many small towns FPs provide a lot of emergency care simply because access to ERs is limited. I'm from a town where the nearest hospital is about 1 hour away and there's no public transportation. Most elderly people can't get to the hospital and if I practiced in town, I would most likely be seen by people who really need emergency treatment. I don't intend to run an ER out of my family practice but since it takes an ambulance nearly 45 minutes to get where I intend to practice, I think ER training would be invaluable for me. Does anyone know anything about combined ER and FM practice? Is it possible to work a few days a week as a FP and then spend a few days a month as an ER physician?

I applaud your goals but I think you might be wasting your time doing an EM residency. While you are correct that your patients with limited access to an ED will come to your clinic you will not be able to do many of the stabilizing interventions you would learn in EM in your office. You will likely not have the equipment to do central lines or intubation, you won't have large supply, high flow O2 or a vent, you won't have a large stock of drugs such as pressors and so on. If you are considering practicing EM in addition to FP then by all means do both. I sympathize with your desire to provide your patients with adaquate emergency care in a difficult setting.

 

[dirtridndoc]

I completely agree with docB's first message (I would advise against doing an FP residency if you plan to work in an ED or do urgent care. There are FP trained docs who work in rural EDs that cannot attract or afford board certified EPs but this is the exception to the national trend.). I disagree, however, with the second. I don't think it would be awaste of time for you to do an EM residency. Let me explain why...

I am a PGY-III in FP. I graduate in June and I am applying for a second residency in EM. My eventual goal is to work and teach in rural EM. I truly believe that I should be board certified in EM if I'm going to practice EM - even in a rural area. MY FP training is in a rural area and I chose my current program b/c it offered an EM/Acute Care track. I originally thought that I would receive training that was adequate for me to practice rural EM. By the beginning of my PGY-II year, however, I realized that this was not possible. In most FP residency programs you will receive one month of EM in your intern year. none in PGY-II, and one month in PGY-III. Obviously there are elective opportunities but depending on where you are located, you still may not be getting the volume of patients and, most importantly, the procedures, to give you the confidence to work in EM. Sure, 70-80% of patient visits to rural ED's are basic outpatient type medicine. Rural areas may not have the "knife-and-gun club" excitement of urban areas, but there are dozens of serious blunt force traumas that require you to be up on your ATLS procedures.

Now obviously, a lot of this depends on where your passion lies. If you are really into Family Medicine, then do a FP residency and you could even consider the EM fellowship (see AAFP web site). Many of our recent graduates and working in rural ED's, without any additional residency or fellowship training. There are still plenty of opportunities for FP's in EM in underserved areas. Be advised, however, that some of the jobs are drying up. Many rural/semi-rural hospitals are actively recruiting EM BC grads to work in rural hospitals (our hospital just hired 2).

If your passion is EM, like mine, then please do an EM residency. If you love EM and want to work in EM, you will be absolutely miserable in a FP residency (sorry to be so blunt). There are more EM programs in states with large rural areas that are attracting applicants who want to work in live in rural/semi-rural communities. Remember, not all EM residents want the "excitement" of urban EM. Nebraska, WVA, VA, PA, NC, GA, Utah, and others all have EM programs that encourage and incorporate rural and community EM training. check out the nSAEM residency catalog. There are some great programs out there for rural EM - i'm interviewing at 2 of them.

Luckily, you have some time to decide what is right for you and I would be happy to answer any of your questions regarding FP training. Please feel free to private message me.

Best of luck.

DirtRidnDoc

PS Sorry for any typos....

 

[Mutt22]

The residency at Nebraska medical Center gives the vast majority of training at a tertiary hospital that is the product of a merger of a private hospital and a university hospital. We do one month in both of our 1st and 2nd years in a rural ER. It is a great experience as you are the only resident in the hospital and usually the only resident in the hospital. A surgeon let me do a couple of chest tubes on patients that were transferred in to see him. My point is, while there is a brief exposure, we don't arrange our curriculum or our training around rural medicine. Labeling our program as such and saying that we have an emphasis in rural medicine was a ploy to get money from the state of Nebraska for funding the residency program. Having said that, most of the graduating residents (a grand total of 6) have gone to more ruralish hospitals.

 

[docB]

I stand corrected to some degree. I just got an ad for these kits that are essentially a code cart in a suitcase. I suppose if a critical patient presented to an office you could use this stuff if you were properly trained. I still don't think that by itself justifies doing an EM residency.

http://www.statkit.com/