ER vs FM?

[skatertudoroga]

Can people who do ER residency then practice as family physicians? Especially if they decide to move to a rural area? And can FM doctors successfully change the city where they practice every single year? Like if they want to do 1yr in nyc and the next year in rural australia?

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[deleted87716]

Can people who do ER residency then practice as family physicians?

Legally, they might be able to do urgent care or piss-poor primary care, but EM residency will not prepare them to do family medicine the way it's supposed to be done.

can FM doctors successfully change the city where they practice every single year? Like if they want to do 1yr in nyc and the next year in rural australia?

Success depends upon the individual and the opportunity. What you've described is known as locum tenums (basically, a hobo doc). Not everybody's cup of tea.

 

[tkim]

Can people who do ER residency then practice as family physicians?

I'm EM trained, and would feel uncomfortable doing FM. Urgent care is where I think EM and FM overlap quite nicely. But go two feet further either way and I think we're out of our depth.

 

[JustPlainBill]

OP- I was told this by an upper level FM resident when I was trying to make the choice between EM vs FM....

An FM doc can work in EDs, but can't do trauma. If that's important to you, go EM.

 

[skatertudoroga]

Legally, they might be able to do urgent care or piss-poor primary care, but EM residency will not prepare them to do family medicine the way it's supposed to be done.



Success depends upon the individual and the opportunity. What you've described is known as locum tenums (basically, a hobo doc). Not everybody's cup of tea.

Thank you for your response. In what kind of situation/disease would a FM doctor make the correct diagnosis in an outpatient setting, while if he were replaced by an EM doctor, the diseases would be missed or incorrectly diagnosed? Or is the harder part of FM the actual management of chronic disease like diabetes? How come for jobs like embassy doctor or cruise ship physician they dont care if you are FM, IM or ER?

I actually looked at locum tenums in exotic places like australia. And I noticed that there are actually more jobs for FM than for EM doctors. To me that seems counterintuitive since I thought the main appeal of ER was its "flexibility".

 

[deleted109597]

OP- I was told this by an upper level FM resident when I was trying to make the choice between EM vs FM....

An FM doc can work in EDs, but can't do trauma. If that's important to you, go EM.

Sorry, but that's not the case. EM docs can't "do" trauma either, since it is a surgical specialty.
FM training does not cover EM training. EM training does not cover FM training. While I agree that a large proportion of the patients are "clinic" patients, it is the ones that aren't that make the difference.
That's not to say that there aren't some FM people out there who have been doing it for years and are good at it. However, the days of FM BC/BE getting into the ED in any city they choose are over. Sure, there will always be rural places, but not many people want to go there.

The sum of it is, train in what you want to do. Otherwise you won't be good at what you do.

 

[skatertudoroga]

What do you all think of canadian system of family medicine? it is 2 years instead of 3yrs. But then you can take an additional year to get full training in either sports medicine, ER, or anesthesia. How would they compare in terms of procedures to the best american fm residencies?

 

[smq123]

Thank you for your response. In what kind of situation/disease would a FM doctor make the correct diagnosis in an outpatient setting, while if he were replaced by an EM doctor, the diseases would be missed or incorrectly diagnosed? Or is the harder part of FM the actual management of chronic disease like diabetes?

Some diagnoses take a while to make, which the ED doesn't have time for. For example, if someone had an autoimmune disease, it can take a few weeks for all the tests to come back to help make a definitive diagnosis. Well, you can't have someone sitting in the ED for those few weeks waiting - it makes more sense for the EM physician to make sure that there is nothing that needs to be taken care of RIGHT NOW, and then send the pt. to an FP to make the final diagnosis.

And yes, managing chronic diseases is one of the more challenging aspects of FM.

 

[deleted87716]

How come for jobs like embassy doctor or cruise ship physician they dont care if you are FM, IM or ER?

Because the job is basically urgent care.

 

[deleted87716]

I thought the main appeal of ER was its "flexibility".

I would argue that FM offers greater flexibility than EM.

In FM, you can work pretty much anywhere. Rural, urban, suburban, solo practice, multispecialty group, hospital system, etc. In EM, you work in the ED (or, maybe urgent care, if you want to waste your training).

In FM, you can do ambulatory care, inpatient medicine, or both. In EM, you work in the ED.

In FM, you can work when you want. If you don't like nights, weekends, and holidays, you don't have to work them. In EM, you work all of those times.

In FM, you decide how many patients you see and when you see them. You can decide what, if any, insurance plans you accept. You can even dismiss patients if it comes to that. In EM, you have little to no control over any of this.

The biggest argument I hear in favor of a shift-work field like EM is that "when you're off, you're off" (meaning you're never on call). In reality, many EM jobs do have an on-call schedule in case somebody calls in sick or something, and most call in FM is pretty easy, especially if you don't do hospital medicine. Even most of the folks who still do hospital have enough coverage that they aren't on call all the time. Even the guys I know who are in solo practice and essentially on call 24/7 say it's not that bad. Since they're accessible during office hours and have good relationships with their patients, they rarely get called after hours unless it's truly urgent. Most of the on-call horror stories you hear about are in practices that pretty much suck all the way around. It doesn't have to be that way.

 

[EdibleEgg]

Can people who do ER residency then practice as family physicians? Especially if they decide to move to a rural area? And can FM doctors successfully change the city where they practice every single year? Like if they want to do 1yr in nyc and the next year in rural australia?

1) No, but they can practice as general practictioners. EM trained physicians shouldn't have any trouble making a diagnosis, but would likely need to do some catching up in management. One of the EM trained docs here got in to a spat with administration over scheduling. He opened up an Urgent Care center that basically functioned as a cash based, same day scheduling, primary care clinic. I can't speak to the care he gave, but I think he did well; he recently retired and works part time at a clinic on the coast.

2) Yes, FP's can move every month if you like. You can't do that if you own your own practice, but there are locums jobs everywhere, from urban to rural. I did it for a couple of years after residency. It was a great way to travel, but it eventually wears on you.

 

[skatertudoroga]

Thank you all for replies. What are the top family medicine programs? And what do you think of the 2yr programs in canada (i.e. McGill and Alberta take americans)?

 

[deleted87716]

And what do you think of the 2yr programs in canada (i.e. McGill and Alberta take americans)?

Too short. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668992/

 

[lowbudget]

In what kind of situation/disease would a FM doctor make the correct diagnosis in an outpatient setting, while if he were replaced by an EM doctor, the diseases would be missed or incorrectly diagnosed?

It's more than just chronic disease management that make us different. Like already mentioned sometimes it takes time to make a diagnosis. In both EM & FM, you need to make decisions with limited/imperfect information. In FM, you train to make an initial impression, work up patients, arrive at a diagnosis, execute your plan, & follow up. In EM, you don't have that luxury. In EM, you make an initial impression, a cursory work up with what you have available & then a disposition and that's the end of the case. In EM, you sometimes don't know if you made the correct decision because care is passed off to someone else. In FM, the follow up allows you to know whether or not you've made the *correct* diagnosis & allows you to learn & refine your practice. It's tough to do that when you treat & street. There's no feedback at all. I think this (among others like acuity) is one of the reasons why EM & urgent care have higher malpractice premiums (& lawsuits) than FM.

Consequently, in FM, you can execute Plan A, & if that doesn't work, you go down Plan B, then C. In EM, if you're unsure, you generally have to do Plan ABCDE to cover your basis. This is why FM is more cost effective than EM & a big reasons why people who have resources & financial means prefer to stay out of the ED when they have a PCP.

 

[deleted109597]

Something on my mind recently has been how there is a large (relative anyway) amount of discussion about both the ABPS "board" and whether or not to allow FM trained but EM working people back into ACEP.
What is the SDN FM take on ABPS and their "practice-track" certification (the vast majority of EM certs through that arm are FM trained people)?
Second, when it comes to FM people on ACEP, is the opposite a possibility? Can non FM boarded people become members of AAFP?

 

[deleted87716]

Something on my mind recently has been how there is a large (relative anyway) amount of discussion about both the ABPS "board" and whether or not to allow FM trained but EM working people back into ACEP.
What is the SDN FM take on ABPS and their "practice-track" certification (the vast majority of EM certs through that arm are FM trained people)?
Second, when it comes to FM people on ACEP, is the opposite a possibility? Can non FM boarded people become members of AAFP?

Being a member of the AAFP isn't the same as board certification, which is overseen by the ABFM. Non-FPs cannot become board certified. Under certain circumstances, however, they can become supporting members of the AAFP.

To answer your question, I think that ABEM eligibility should be available to FPs who complete an approved EM fellowship, similar to what the ABEM itself recently announced for EPs who want to be boarded in IM/CCM.

 

[JackADeli]

What do you all think of canadian system of family medicine? it is 2 years instead of 3yrs. But then you can take an additional year to get full training in either sports medicine, ER, or anesthesia. How would they compare in terms of procedures to the best american fm residencies?

Frightening....
My read on it is this. You have 2 foundation years. While yes, it can be very specific and intense to maximize those two years... if a particular and specific goal is planned for at the completion of the third final year. But, it seems that a final goal is not set as those 2 years are ?concentrated to becoming FM and can be applied sports med/er/anesthesia???!!!

It is frightening to imagine a broad general two years making FM and just tack a year on to be anesthesia and such!

 

[EdibleEgg]

Being a member of the AAFP isn't the same as board certification, which is overseen by the ABFM. Non-FPs cannot become board certified. Under certain circumstances, however, they can become supporting members of the AAFP.

To answer your question, I think that ABEM eligibility should be available to FPs who complete an approved EM fellowship, similar to what the ABEM itself recently announced for EPs who want to be boarded in IM/CCM.

I agree. The ABEM leadership puts out contradictory statements about this quite often, and it really all comes down to "turfism". They support EM to Critical Care but absolutely oppose FP to ER. They even seem to support NP's working solo in the ED. When this thread started, I compared the curriculum of the EM program to the FP program at my alma mater. The only the basic difference is the FP's send a year doing inpatient medicine while the EM's spend a year in the ER. From purely curriculum standpoint, FP's with an EM fellowship have done every rotation a three year EM resident has plus a year of inpatient medicine.

 

[JackADeli]

...The ABEM leadership puts out contradictory statements ...They support EM to Critical Care but absolutely oppose FP to ER. ...I compared the curriculum of the EM program to the FP program at my alma mater. The only the basic difference is the FP's send a year doing inpatient medicine while the EM's spend a year in the ER. From purely curriculum standpoint, FP's with an EM fellowship have done every rotation a three year EM resident has plus a year of inpatient medicine.

I always found this somewhat peculiar. It is interesting on how motivated ER has been to be critical care.

I have also been surprised at how it hasn't seemed like FM has really supported the issue of FM getting critical care... I definately appreciate/understand the colleges position on breadth and such. It just seems like additional accredited training options have not been fully explored. It surprises me to see adolescents/geriatrics/sports med/women's health being the only ones (I think) that seem supported. I think some well designed additional options for those with such aspirations may increase the interest in FM.

 

[deleted109597]

Being a member of the AAFP isn't the same as board certification, which is overseen by the ABFM. Non-FPs cannot become board certified. Under certain circumstances, however, they can become supporting members of the AAFP.

I know it isn't the same as board certification. Just like being a member of ACEP isn't a board certification. I was asking if you can become a fellow of the college/academy without residency training, and apparently that answer is "no". Supporting member does not equal fellow.
The board portion was pertaining to the ABPS (as opposed to ABMS) and them going out and giving "board certification" in basically whatever you want if you were willing to show you had done it for awhile. The issue was that initially Texas was willing to accept their fake board as a real one.

To answer your question, I think that ABEM eligibility should be available to FPs who complete an approved EM fellowship, similar to what the ABEM itself recently announced for EPs who want to be boarded in IM/CCM.

I always found this somewhat peculiar. It is interesting on how motivated ER has been to be critical care.

I have also been surprised at how it hasn't seemed like FM has really supported the issue of FM getting critical care... I definately appreciate/understand the colleges position on breadth and such. It just seems like additional accredited training options have not been fully explored. It surprises me to see adolescents/geriatrics/sports med/women's health being the only ones (I think) that seem supported. I think some well designed additional options for those with such aspirations may increase the interest in FM.

The difference is that when EM residents do CC fellowships, they go through already accredited fellowships run by other specialties. These aren't CC that are started up by EM. So they were doing the training and not getting the credit.
I don't have a problem with ABEM making EM fellowships for FM/IM/whatever. However, the FM fellowships that exist are run by FM programs without ABEM accreditation. It's likely political, but there is a difference.

I agree. The ABEM leadership puts out contradictory statements about this quite often, and it really all comes down to "turfism". They support EM to Critical Care but absolutely oppose FP to ER. They even seem to support NP's working solo in the ED. When this thread started, I compared the curriculum of the EM program to the FP program at my alma mater. The only the basic difference is the FP's send a year doing inpatient medicine while the EM's spend a year in the ER. From purely curriculum standpoint, FP's with an EM fellowship have done every rotation a three year EM resident has plus a year of inpatient medicine.

Using your words, then EM is just as qualified to do outpatient FM, since everything else is the same and we don't do as much inpatient. I disagree respectfully. And, as has been demonstrated, doing "offservice" rotations you get less instruction on the core measures than "onservice" residents get. Typically it is worded as something like, "these are the things you need to know that pertain to your field". So the "extra" year of EM is really a year of specialty specific training, lectures that only apply to EM, and immersion in what emergency medicine is.
There is a reason that there is different training for different specialties, and not all of it is political.

 

[deleted87716]

Supporting member does not equal fellow.

Technically, FPs who are board-certified are known as "diplomats" of the board, not "fellows." Fellowship is another step beyond board certification. In family medicine, fellowship is denoted by the initials "FAAFP." Diplomats of the board may use "ABFM" to signify board certification.

I know you probably don't really care about any of this, but since we're in the FM forum, we might as well use the correct terminology.

I don't have a problem with ABEM making EM fellowships for FM/IM/whatever. However, the FM fellowships that exist are run by FM programs without ABEM accreditation. It's likely political, but there is a difference.

I agree. For board eligibility in EM, the fellowships should be accredited by the ABEM.

 

[deleted109597]

I know you probably don't really care about any of this, but since we're in the FM forum, we might as well use the correct terminology.

Well, since the brouhaha is about FM people becoming FACEP (ie fellows of ACEP), I was asking if EM people can become FAAFP. I think we are discussing different points. I know EM people can't be boarded in FM (except through ABPS, which isn't universally recognized).

 

[Hamhock]

To answer your question, I think that ABEM eligibility should be available to FPs who complete an approved EM fellowship, similar to what the ABEM itself recently announced for EPs who want to be boarded in IM/CCM.

FM:EM is not EM:CCM

The two are not analogous.

If the proposed EM/CCM plan goes through, EM docs who complete a CCM fellowship will not be IM/CCM board eligible. It has nothing to do with IM. They will be board eligible for CCM and EM board eligible...not IM board eligible.

These EM docs will complete the full and identical two years of fellowship that their classmates with a base specialty in IM complete. Same rotations. Same time in fellowship. Same everything. To get the same board eligibility.

An FM-trained doc has an analogous option to becoming board eligible in EM: the FM doc can complete the same rotations, same time, same everything as an EM resident...it's an EM residency. It is of note that docs with prior FM training may get 6 months off the required 36 months of EM residency for "prior training". So, FM docs can be board eligible with a 2.5 year EM "fellowship" - but it is residency.

You should only be board eligible for something you have completed the board eligibility requirements for. EM docs who complete the CCM board requirements should be eligible CCM board cert. FM docs who complete the requirements for EM board eligibility should be eligible for EM board cert. Nothing less in either case.

HH

 

[deleted109597]

Sigh. We are talking at each other it seems.
I guess I'm not being clear. I know these things
Board certification =/= membership to specialty society
Membership in society =/= fellowship
However, the crux is that FM doctors want to be members of ACEP, and potentially become fellows. Many in ACEP do not want this. I was asking if non-FM doctors could become members of the AAFP beyond the "supporting member".

The board certifications I keep referring to are the clown college ABPS boards that are not universally recognized, unlike the ABMS. I am not equating either of them, which is why in the original post, I had two separate points. I guess I should have numbered them with numerals.

 

[deleted87716]

In my mind, ABEM board certification is the important credential. Membership in a specialty society doesn't have anything to do with competency.

For that reason, I don't know why an FP would want to belong to ACEP, unless - as you suggested - they got their "board certification" from a non-ABMS certifying body (e.g., "clown college") and are hoping that ACEP membership will help legitimize their credentials.

I feel the same way you do. If they haven't completed an ABEM-accredited EM residency (or, maybe someday, a fellowship), I don't think they should be allowed to join.

 

[EdibleEgg]

I don't have a problem with ABEM making EM fellowships for FM/IM/whatever. However, the FM fellowships that exist are run by FM programs without ABEM accreditation. It's likely political, but there is a difference.


Using your words, then EM is just as qualified to do outpatient FM, since everything else is the same and we don't do as much inpatient. I disagree respectfully. And, as has been demonstrated, doing "offservice" rotations you get less instruction on the core measures than "onservice" residents get. Typically it is worded as something like, "these are the things you need to know that pertain to your field". So the "extra" year of EM is really a year of specialty specific training, lectures that only apply to EM, and immersion in what emergency medicine is.
There is a reason that there is different training for different specialties, and not all of it is political.

I doubt the ABEM is going to start or even support any EM fellowships any time soon, and yes a big chunk of that is political.

No, EM is not just as qualified, but would be after a year of an FM fellowship if such a thing existed. I realize the two specialities have a very different focus and scope. But I don't disregard all you learn about atrial fib in an EM residency just because you don't manage it longitudinally. I agree that the twelve months of rotations provide specialty specific training. I'm just saying that if an FM trained doc went through that specialty specific year the end result would be equivalent to an EM trained doc. There is more than six months of similarity between the two specialities.

I don't really care that much about this, and in general think that you should do an EM residency if you want to be an ER doc (full disclosure, I do work part time in a rural ER). However, recently read an editorial from some of the ABEM leadership that basically supported NP's working solo in rural ER's, but denounced PHYSICIANS trained in FM/IM doing the same in the that article. That's just crap.

 

[EdibleEgg]

sorry double post... iphone...

 

[deleted109597]

However, recently read an editorial from some of the ABEM leadership that basically supported NP's working solo in rural ER's, but denounced PHYSICIANS trained in FM/IM doing the same in the that article. That's just crap.

Yes, that dialogue appeared in one of the monthly "throwaways". I too disagree with the notion that somehow a NP is better qualified than PC docs.
I also disagree that I would somehow be a good family doc with 1 year of fellowship.

 

[EdibleEgg]

Yes, that dialogue appeared in one of the monthly "throwaways". I too disagree with the notion that somehow a NP is better qualified than PC docs.
I also disagree that I would somehow be a good family doc with 1 year of fellowship.

I didn't say that YOU would make a good family doc....

What is it that you get in an EM residency that is so magical? Maybe I missed something in residency. My job is difficult, and it does require a significant amount of knowledge and skill. However, there was not a single aspect of residency that pulled it all together. I get your earlier point about speciality specific training, and that exists in an FM residency. But, there is nothing so specific that it couldn't be pulled together in an additional year after EM (and vice versa).

 

[JackADeli]

...I compared the curriculum of the EM program to the FP program at my alma mater. The only the basic difference is the FP's send a year doing inpatient medicine while the EM's spend a year in the ER. From purely curriculum standpoint, FP's with an EM fellowship have done every rotation a three year EM resident has plus a year of inpatient medicine.

I think this is the point that enable integrated dual boarding programs, i.e. med-pedes. I guess making it an integrated program as opposed to an add-on year can assure some quality assurance... But, if all that you lack is a dedicated year of ER training and your core training before meets or exceeds the other training requirements....? This really shouldn't be such a turf war, IMHO. It doesn't belittle either field. To argue to the contrary and/or against may on the otherhand belittle each field and adversely impact credibility.

...I also disagree that I would somehow be a good family doc with 1 year of fellowship.

Honestly, if you lack twelve months of clinical training.... what is so magical about going ahead and getting that 12 months of training. Why would someone think they wouldn't be qualified and/or competent to practice if they had completed the training? I will admit that given the "longitudinal" aspect to FM training, it seems without an integrated program, it would be hard to do a 1yr fellowship for an ED physician to FM. But, ER is not longitudinal in the same manner and so it may be easier to fellowship an FM into ER.

 

[deleted87716]

Combined residency programs usually accomplish more in less time because they eliminate a lot of electives (e.g., Christiana's combined FM-EM program takes seven years of FM and EM training and condenses it to five.)

A separate EM fellowship that met ACGME requirements would probably take at least two years.

 

[deleted109597]

I didn't say that YOU would make a good family doc....

Honestly, if you lack twelve months of clinical training.... what is so magical about going ahead and getting that 12 months of training. Why would someone think they wouldn't be qualified and/or competent to practice if they had completed the training? I will admit that given the "longitudinal" aspect to FM training, it seems without an integrated program, it would be hard to do a 1yr fellowship for an ED physician to FM. But, ER is not longitudinal in the same manner and so it may be easier to fellowship an FM into ER.

Ok, I don't think anyone would be a competent FM doc after a 12 month fellowship. Honestly, if I were an FM attending I would be offended that someone with no training in FM could somehow be good at it with just 1 year of fellowship.

What is it that you get in an EM residency that is so magical? Maybe I missed something in residency. My job is difficult, and it does require a significant amount of knowledge and skill. However, there was not a single aspect of residency that pulled it all together. I get your earlier point about speciality specific training, and that exists in an FM residency. But, there is nothing so specific that it couldn't be pulled together in an additional year after EM (and vice versa).

I think this is the point that enable integrated dual boarding programs, i.e. med-pedes. I guess making it an integrated program as opposed to an add-on year can assure some quality assurance... But, if all that you lack is a dedicated year of ER training and your core training before meets or exceeds the other training requirements....? This really shouldn't be such a turf war, IMHO. It doesn't belittle either field. To argue to the contrary and/or against may on the otherhand belittle each field and adversely impact credibility.

Simply put, in 3 years of FM, you get 3 years of FM lectures. Things like which second line agent to start with diabetics. What A1c to go for. Pap smear training. Immunization schedules. Hypertension management. Outpatient and Inpatient management of various and sundry chronic conditions. EM gets absolutely none of that.
You also get things like central lines, pressors and the like, but it is a small amount. This is the overlap.
EM gives you three years of EM lectures. Rabies vaccinations. Toxicology. Ultrasound use (for most programs now). EGDT for sepsis is hammered into you. There are plenty of other things.
Yes, you can "look up what you don't know", but with that logic, I could do a whipple procedure if I looked it up.

Most FM programs don't have their residents in the ED for 12 months. In fact, I haven't seen any that give their residents more than 3 months in the ED. Most EM programs have their residents in the ED for more than 24 months (on the interview trail, you hear a lot of "you learn emergency medicine in the emergency department"). Not only is lecture important, actually doing it is important. Which is why the RRC has requirements to be "competent".

Adult medical resuscitation:45
Adult trauma resuscitation 35
ED Bedside ultrasound 40
Cardiac pacing 6
Central venous access 20
Chest tubes 10
Procedural sedation 15
Cricothyrotomy 3
Disclocation reduction 10
Intubations 35
Lumbar Puncture 15
Pediatric medical resuscitation 15
Pediatric trauma resuscitation 10
Pericardiocentesis 3
Vaginal delivery 10

Some of these are easily obtained in FM, IM, peds, etc. But not all. Just like there are likely FM requirements that you aren't going to get in the ED.
As BlueDog pointed out, there is a reason ABFM and ABEM think that to be trained in both, you need 5 years of training. Similarly, ABIM and ABEM, and ABP and ABEM think that the combined residencies are best done with 5 years, because the overlap isn't as great as you think.

 

[EdibleEgg]

Ok, I don't think anyone would be a competent FM doc after a 12 month fellowship. Honestly, if I were an FM attending I would be offended that someone with no training in FM could somehow be good at it with just 1 year of fellowship.

I'm not offended by the notion that someone with similar training and experience could be good at my job.

Simply put, in 3 years of FM, you get 3 years of FM lectures. Things like which second line agent to start with diabetics. What A1c to go for. Pap smear training. Immunization schedules. Hypertension management. Outpatient and Inpatient management of various and sundry chronic conditions. EM gets absolutely none of that.
You also get things like central lines, pressors and the like, but it is a small amount. This is the overlap.
EM gives you three years of EM lectures. Rabies vaccinations. Toxicology. Ultrasound use (for most programs now). EGDT for sepsis is hammered into you. There are plenty of other things.
Yes, you can "look up what you don't know", but with that logic, I could do a whipple procedure if I looked it up

.

You don't learn to practice medicine through lectures. Seriously... pap smear training? You can't do a pap smear? I know you don't do them in the ED, but are you saying that you can't do one?

Most FM programs don't have their residents in the ED for 12 months. In fact, I haven't seen any that give their residents more than 3 months in the ED. Most EM programs have their residents in the ED for more than 24 months (on the interview trail, you hear a lot of "you learn emergency medicine in the emergency department"). Not only is lecture important, actually doing it is important. Which is why the RRC has requirements to be "competent".

I'm not saying that a 12 month fellowship would give you exactly the same number of ED shifts or exactly the same training. It would produce physicians with a similar level of competence. The numbers you list have very little to do with competence, but you could easily attain the numbers in a year long fellowship. The only things I didn't do in a FM residency were cricothyrotomy, pericardiocentesis, and trauma (although pending on your definition of resusitation, I may have met the adult numbers there as well). I did more than 40 ED ultrasounds, but I'm still not comfortable with them.

Some of these are easily obtained in FM, IM, peds, etc. But not all. Just like there are likely FM requirements that you aren't going to get in the ED.
As BlueDog pointed out, there is a reason ABFM and ABEM think that to be trained in both, you need 5 years of training. Similarly, ABIM and ABEM, and ABP and ABEM think that the combined residencies are best done with 5 years, because the overlap isn't as great as you think.

They didn't invite me to the meeting, but I think a big portion of that reason is political. We could go on and on about this, but as an FP who works part time in a rural ED (in addition to my full time practice) I think there are a lot of similarities. If you consider a suburban, primarily adult, outpatient only practice and a busy urban trauma center, the difference is night and day. The further you go from those extremes, the more overlap there is. I completely agree that EM is a legitimate speciality, and the best docs in the ED are EM trained. However, I usually work the swing shift which is generally double covered. The EM guys don't save every patient. The IM guys aren't clueless; they don't bring death and destruction. At least some of the skills they learned in residency translate.

 

[AFSmiley]

My problem is this:

IM/Peds have managed to have combined programs that are 4 years long,

What the crap! Seriously, I really think there's enough overlap that a 4 yr dually accredited program would be possible.

I don't have specifics but that's just my gut after going through 3rd year, doing 6 weeks of Family and doing 4 weeks of ER at the beginning of my 4th year here.


Oh well.......

 

[JackADeli]

...IM/Peds have managed to have combined programs that are 4 years long,

...Seriously, I really think there's enough overlap that a 4 yr dually accredited program would be possible.

I don't have specifics but that's just my gut...

Remember, IM probably has little to no pediatrics & pediatric lectures, etc.... Pedes likely has no adult med, no adult lectures. The same goes for their outpt clinical experience as well. But, with a well planned structure they are able to unify into a 4 yr program.

I am no expert on either FP/FM or EM. However, It seems that a well developed integrated program could be done in 4 years as opposed to 5yrs. My gut tells me making it 5 yrs is just a way of making it sufficiently unpleasant idea that nobody moves forward to do it. My intuition says the 5yr thing is more politics the education/training agenda.

 

[deleted87716]

My intuition says the 5yr thing is more politics the education/training agenda.

Probably. Here's an interesting take on the 3 vs. 4 year EM training programs. There's even the suggestion that 2 years would be sufficient.

http://www.saem.org/SAEMDNN/Portals/0/CDEM/EMapplicantsDoc/06RosenHamilton3vs4yearResidency.pdf

 

[JackADeli]

Probably. Here's an interesting take on the 3 vs. 4 year EM training programs. There's even the suggestion that 2 years would be sufficient.

http://www.saem.org/SAEMDNN/Portals/0/CDEM/EMapplicantsDoc/06RosenHamilton3vs4yearResidency.pdf

Thank you!!! That is very interesting. I am certain the EM program made a real argument about how their field could produce competent trained specialists in 2 years at the initial outset.... now to read the arguments for 3-4 years required....

I find it very telling, especially the part of how EM residents being required to do additional years is often just used as a means of man-power/warm body coverage for the attending staff and not really for the purpose of education or training.

 

[deleted109597]

Thank you!!! That is very interesting. I am certain the EM program made a real argument about how their field could produce competent trained specialists in 2 years at the initial outset.... now to read the arguments for 3-4 years required....

If you read it critically, you find that most 2 year starts were because that was all they could get funding for. Considering that the average "ER" doc had only done internship, this was a 100% increase in length. The first EM resident started in 1970 and made his own residency, as EM did not exist. Only 2 of his 24 months were in the ED. Before 1969, all GP residencies were 1-2 years long, so it isn't like EM was vastly different.

I find it very telling, especially the part of how EM residents being required to do additional years is often just used as a means of man-power/warm body coverage for the attending staff and not really for the purpose of education or training.

Nah, the 4 year programs are slowly fading. UAB went from 2-4 to 1-3. A lot of resistance to changing the programs that are there are the faculty, and they all did 4 years too (they're frequently required to). Those faculty "feel" that 4 years is better than 3. They also push for the academic aspect, and many of the 4 year places allow you to do a "mini-fellowship".

Conversely, FM literature is rife with people talking about making residency 4 (or more) years long. (The Journal of the American Board of Family Practice, Vol 15, Issue 3 201-208;The Journal of the American Board of Family Practice 17:391-393 (2004)). In fact, the reason it was started at 3 years is because the founders felt there was too much breadth for 1 or 2 years of training to adequately cover it, and fewer people were becoming GPs.

 

[deleted87716]

FM literature is rife with people talking about making residency 4 (or more) years long.

There's also talk of making it shorter. Most of us, however, feel that three years is the right length.

 

[JackADeli]

If you read it critically, you find that most 2 year starts were because that was all they could get funding for...

I understand what it says and again, your point is interesting. I again say that I am sure someone made a strong argument about being able to train to competence within 2yrs in order to justify said funding. To argue we will train for only 2yrs, though is not fully trained rather our funding is consumed/out, would not be reasonable. i.e. basing training length primarily on funding as opposed to required education to achieve competence...... I am certain applicants for those new programs were told how they would be fully competent in this "new field" and they will be the cat's meow.

Otherwise, you are describing.... a group that got together, knew they could not fully train residents, but wanted funding to do some training, so accepted these dollars and told fresh med grads they could be trained. It would bring into question the integrity of the entire group.