Failed to Match Into EM - What Now?

Discussion in 'Emergency Medicine' started by monkeymedic, Mar 20, 2016.

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  1. Vandalia

    Vandalia 2+ Year Member

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    A lot of the contracts between the CMG and the hospital require the CMG to staff with only BC/BE physicians. Otherwise, you are correct, they would be greatly tempted to minimize their labor costs.

    It is theoretically possible for a FM/IM residency grad to work their way into one of these type-places (and I am not talking about those grandfathered into EM board certification.) It usually starts by working at a very rural affiliated hospital, getting a great reputation there, being invited to the "big city", and then developing a good enough reputation that you can be hired most places despite the residency/lack of board certification. BUT, today that is incredibly rare. It is like getting an EM residency with a Step 1 score of 195. You might be able to find one person who did that, so it is theoretically possible, but don't bank on it.
     
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  3. BlackDynamite

    BlackDynamite

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    I've got no problem commuting to a rural ER for a few 24 hour shifts every month. It would also be nice to work in a suburban ER but I could live without that opportunity. I would like a clinic with "my" patients and to do volunteer work in third world countries. Is FM the better option for those choices? I may also apply to a combined EM/FM program, but I know that's unlikely given the number of spots.


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  4. cbrons

    cbrons Ratatoskr! *Roar* Bronze Donor 7+ Year Member

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    If you failed 4th year, and had to repeat it, by the time you apply that would be a fairly recent occurrence. On the other hand, if you failed a class first year, when your just acclimating to school, whatever, yet still did well the rest of your career, then I would think that's not as bad.
     
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  5. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    If your goal is rural ED, run a clinic and do overseas medicine, then yes, FM is a better route than EM. That being said, as you get married and have kids, your priorities will change. Driving out to the country to work a 24h shift sounds much less appealing when your wife has to stay alone overnight. Going out of the country seems less appealing when your student loans are due.
     
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  6. Angry Birds

    Angry Birds 5+ Year Member

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    I've done almost two years of the 24 hour thing and I'm forever done with it. And I thought foolishly that I would love 24 hour shifts.
     
  7. BlackDynamite

    BlackDynamite

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    I'm married and have a kid. Just did a week of nights... Wife spent half of every day alone. It was not good. I guess at least if the ER thing is more part time, I can back off as needed. I know burnout is high.

    And for international work... I mean more like 1-2 weeks a year.


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  8. BlackDynamite

    BlackDynamite

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    What did you not like about it?


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  9. racerwad

    racerwad 7+ Year Member

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    I think your point is fair and worth discussing in one's PS and interview (if you make it that far), but a failure is a red flag no matter when it occurred.
     
  10. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director

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    No offense, but my interns are better ER docs than any graduating FP resident rotating in my ED. No other residency trains you to deal with the volume, complexity, and variety of EM. FP physicians are no more prepared to go work in an ED than I am prepared to go take out someones appendix in the OR.

    Will these new EM fellowships for FP docs help? Sure. But only to a point. While they may give the trainee more background and time in the ED, they aren't a substitute for 3 years of residency where you do months and months of medical, surgical, and trauma critical care along with learning how to manage the chaos of an ED.
     
  11. Angry Birds

    Angry Birds 5+ Year Member

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    1) Shifts are long as ____.
    2) Hard to sleep in a hospital.
    3) Kills 3 days. I have to sleep early the night before (by 9:30 pm). Then, sleep much of the "post-call" day.
    4) Hard on the wife/family.
    5) Volume at my ER is way too high for this. If it was half what it is now, then maybe it would be much better.

    Of course, I'm doing this since I'm doing a fellowship and further degree on the other days. So, that has a lot to do it (i.e. no real days off), but even still, I don't think I'd ever go back to this.
     
  12. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    What fellowship/degree?
     
  13. Angry Birds

    Angry Birds 5+ Year Member

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    I'll PM you.
     
  14. BlackDynamite

    BlackDynamite

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    You're comparing a board certified physician to a fifth year medical student? What a cheap shot. Can we keep the defensive and insecure insults out of this?

    No offense, but my first year critical care fellows are way better at critical care than an EM grad. No learning actually takes place on those very few ICU off service months. If you want to learn some critical care, go do a fellowship. You've got no business even thinking you could begin to comprehend critical care.

    If you exclude the ICU experience of an off service intern shadowing an upper level resident. You're essentially comparing ED months. FM + fellowship is 21 vs. EM residency which is ~23.

    But because a FM + fellowship graduate lacks 2-3 months of ED experience in residency I'll just turn down my $235/hour job offer and let a nurse or technician figure out how to stabilize the next rural MVA victim. Sounds like you're the only one who benefits from that decision.




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  15. Makati2008

    Makati2008 SDN Moderator 7+ Year Member

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    Reviewing your previous posts, you are a student. You have no ideal of the training an EP goes through on a daily basis???

    ICU is where EPs learn a ton of critical care, but as a student it would be hard for you to grasp everything the resident is going through until you actually live it.


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  16. racerwad

    racerwad 7+ Year Member

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    I don't understand what you're getting at? Just because you complete "a" residency, doesn't mean you aren't qualified to practice in any specialty. It doesn't mean you aren't competent in your own field, it just means that you aren't competent in other fields.

    We all don't see the world the same way, and those differences in perspectives are also reflected in the way different specialties approach the same disease. By and large, most FPs chose their field for the longitudinal, non-acute nature how they interact with patients and their illnesses. That is contrary to how EM is practiced - we see patients for a moment in time due to acute illness or acute decompensation of chronic illness. The way that pts present isn't that difference, but the mental approach is.

    I don't see why you're getting so upset about these distinctions. It isn't like they were established to single you or anyone else out.

    Finally, why wouldn't we, emergency medicine physicians in the emergency medicine sub-forum not support EM-trained grads in ED?
     
  17. BlackDynamite

    BlackDynamite

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    And as an EM grad you have no idea what training a FM goes through, except you do because he's training next to your residents in your ED.


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  18. BlackDynamite

    BlackDynamite

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    You're making it sound like the EM residents stabilize a DKA patient while a FM resident in the same ED is on the phone refilling their lantus.

    I'm not surprised you're supporting EM grads in the ED. I'm just disappointed that scientifically minded intelligent people are refusing to at least entertain sound logic.


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  19. Druggernaut

    Druggernaut Lifetime Donor 7+ Year Member

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    What? Our FM residents do one month of emergency medicine alongside us, don't see really sick patients, and are held to a much lower standard.

    Edit: Just looked at their curriculum. One pediatric EM month, one EM month with us, one EM month at a lower acuity private ED. One month of ICU.
     
    Last edited: Apr 23, 2016
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  20. Makati2008

    Makati2008 SDN Moderator 7+ Year Member

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    I'm a resident. But have about a decade of EM experience in other avenues. If you are wanting to practice emergency medicine why not get the best training possible? I wouldn't want ANYTHING less for my family if they were in the ED.

    Believe me I would NOT want to try to practice as a Family Physician due to numerous gaps in my knowledge base that would be associated with their training. I know they aren't getting the same training as I am EP so I would expect similar gaps in their knowledge.


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  21. Makati2008

    Makati2008 SDN Moderator 7+ Year Member

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    They can do one EM rotation each post graduate year here and the most that I have known of them doing here is LP/Suture/Splint. No lines/tubes/etc...

    Pgy1 here is 8 months of EM. Why not apply EM if interested....



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  22. racerwad

    racerwad 7+ Year Member

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    No, it is just that for a given FM resident managing the DKA pt, the EM resident will be managing that pt as well as a handful of others simultaneously. And again, there are always exceptions to the rule, but it is my experience the off-service folks often decline any invasive procedures, including basic stuff that others have already mentioned but are critical to being able to manage an ED. This is also on top of the always looming pt surge that needs to be accounted for. We all know how busy a clinic day can be, but we also know that they won't get much busier than what is scheduled, so you can allocate brain space accordingly. And the reason the schedule won't get busier? Exactly, the ED that is capable of managing any general or sub-specialty clinic pt that is open 24/7/365 that folks in the clinic can send overflow pts to.

    I think the sound logic you're alluding to would say that in order to be successful in a given specialty, one needs to train in that specialty. The suggestion that a specific practice of medicine can be mastered through an unrelated training program is just..illogical. Just because much of what EM and FM do are similar does not mean that the entity of the practice of these two specialties are the same. It would be analogous to suggest that a general surgeon could be an ob/gyn or CT surgeon because they all do similar things; of course, despite all of the cutting, sewing, and temper tantrums (I kid!), a general surgeon is not an OB who is not a CT surgeon because of all the obvious reasons.
     
  23. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    What is happening to this thread?!?!
     
  24. GimpGenius

    GimpGenius 5+ Year Member

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    Med student calling out an attending for not knowing what he's talking about and being insecure. Normal SDN stuff, nothing to see here. ;)
     
  25. BlackDynamite

    BlackDynamite

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    So to summarize... Using all electives and fellowships appropriately... 21 months of ED training under a boarded EM doc at an unopposed residency where tubes lines etc are taught... Is insufficient training to work in a LVL 3 ED where most trauma is flown out. Got it. Maybe you should reconsider moonlighting privileges at your program if that's the case, but I think I see what's going on here...


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  26. BlackDynamite

    BlackDynamite

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    If I were insecure, I wouldn't be pursuing legitimate training that my colleagues are apparently disgusted by.


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  27. Cinematographer

    Cinematographer More chill in real life Gold Donor 5+ Year Member

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    @BlackDynamite, go into EM if you want the job offerings of EM-trained grads. Period. Your whining on here won't change the employment prospects or widely-held opinions on FM grads working in the ED, regardless of whether they've done an EM fellowship or not.
     
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  28. BlackDynamite

    BlackDynamite

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    Please see above posts for clarification. I'm not going to exchange insults with a stranger on the internet.


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  29. sylvanthus

    sylvanthus EM/IM/CC PGY-4 7+ Year Member

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    Can someone get this guy out of here? He is not going to listen to any reason or opinion other than his own, the discussion is pointless.
     
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  30. Janders

    Janders Senior Member 10+ Year Member

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    Um, Apples to Oranges to Bananas?

    (1) Mr. Black Dynamite seems to want to compare a theoretical person who completed an FP residency with all their electives in EM, AND did an extra year of fellowship in EM, totally 21mo of EM training.
    (2) As opposed to most FP training, which is about 3-4mo of ED time typically not held to the pace-standard or procedural-standard of the equivalent EM resident (though ymmv).
    (3) As opposed to typical 3-4yr focused EM residency.

    I think we all understand #3 >> #2 if your goal is to be the best ED doc. #2 makes a damn better family practice doc of course. #1 seems to be a rarity, but I agree would be much closer to #3 as far as ED skills, though not knowing many examples of someone who pulled off #1 I can't say they are truly equivalent.

    Also, the notion that a rural doc in a level 3 trauma center can get away with being less good is ridiculous. Perhaps there are more job opportunities, but when you are ALL ALONE with minimal help and consultants... thats when you need to be a damned fine ED doc!
     
  31. GimpGenius

    GimpGenius 5+ Year Member

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    Problem is, you're taking it personally. EM seems to lend itself to certain personality types (thick skin, gallows humor, etc.). If you can't take criticism on an online forum, it doesn't bode well for residency/practice.

    If you think the fellowship will meet your career goals, best of luck getting it, sincerely. I'm just not seeing the point of you getting snippy with people here when you seem to have made your decision already.
     
  32. Angry Birds

    Angry Birds 5+ Year Member

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    Off-service residents do not get treated the same as EM residents, even EM interns. Off-service residents are treated as extra's, and just see whatever number of patients they want to see and whichever patients they want to see. Moreover, they are excluded from seeing the sicker patients. Having a structured EM residency is what allows you to ascend the ranks of responsibility. So, even if you theoretically spent an equal number of days as a non-EM resident in the ER, you still wouldn't get the same experience. Not even close.
     
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  33. BlackDynamite

    BlackDynamite

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    This is the kind of info I'm looking for. Thank you. That's good to know.

    Is one treated like an "off service resident" in an unopposed FM residency where it's just you and an ABEM doc though?

    Serious question.


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  34. racerwad

    racerwad 7+ Year Member

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    Just stop. No one here is "disgusted" by your training. FP residency does a great job of making FM attendings, but it is a poor substitute for a real EM residency.
     
  35. Angry Birds

    Angry Birds 5+ Year Member

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    I don't think you will be treated as an ER resident even in that situation.

    During my residency, I did work one block a year at a community ER, where I would be the only resident with the ABEM doc(s). However, I did not run the ER there. Rather, I saw a fraction of the patients and reported to the community ER doctor, who was not used to being an ER attending at an academic institution. The ER docs here saw me as an "extra" and were very grateful for me being there and seeing *any* patients.

    At an ER residency, the ER senior residents *run* the ER. The attendings sit back and chill (in the sense that they delegate supervisor role to the senior resident and only intervene as little as possible). The level of acuity and responsibility is wholly different than the community ER situation described above, which honestly was considered our chill month.

    This is why you need a SLOR from an EM residency program, since it is understood that it is a completely different ballgame than some random community ER.

    Having said that, I'm not here to diss your FP training. Also, I think if you don't match into EM and really want to do EM, then the EM fellowship is not a bad option, even if that conflicts with my job security and company line.
     
  36. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director

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    Well clearly I offended you, which wasnt my intent. But you arent being reasonable in your reply. I said Id take an Em PGY1 over a graduating FP doc (pGY3). I stand by that. The off service residents that rotate through my dept as 2nd and 3rd years see less patients and need more handholding than our interns do, and its not close. A PGY1 isnt a 5th year med student anymore than a PGY3 is a 7th year med student.

    Sure if one of the FP docs had experience moonlighting in a small ED and did a fellowship, sure they'd have improved skills from that of a standard trained FP doc and have a readonable claim to working in EM, its just not the preferred route, and they'll always be second class providers working in underserved spots. Places that have options arent going to hire unboarded physicians, even if they are less expensive.

    As for the rant about critical care, I dont understand your point. I agree with you. Im not a critical care doc. I dont apply for privaleges to work in the ICU nor did I claim EM physicians should be staffing ICUs. I have critical care skills, just as I have procedural skills, OB skills, ENT skills, anesthesia skills, etc. But I would never be so arogant as to think I could just apply for an Anesthesia, Gen Surgery, ICU, ENT, or OB/GYN job. I didnt train in those fields and Im not boarded in those fields.
     
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  37. Angry Birds

    Angry Birds 5+ Year Member

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    One more thing: to get an idea of what it's like to be an ER resident, watch Code Black (the documentary, not the tv series). It's on Netflix.

    That is an accurate representation of what ER residency is like. At least the type of training I got at a university hospital level one trauma center.

    You will then appreciate how completely different that is from working shifts in a community ER as a solo resident with a community ER Doctor. I say this as a community ER Doctor. The stress level, volume, acuity, responsibilities, supervisory role as a senior resident, etc. -- it's completely different. No comparison whatsoever.

    It's because of my training at the mother ship--which is like a zoo or a jungle at times--that I'm well prepared for the community setting. I sometimes think back to residency and get palpitations-- that's truly a crucible and someone who hasn't gone through that crucible can't truly understand.

    (Forgive the typos and random capitalizations. This is typed from my phone. )
     
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  38. BlackDynamite

    BlackDynamite

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    I will definitely check out code black.

    I guess I'm just confused as to how training under a community ER doc in a community ER fails to qualify me to work in a community ER. I wasn't ever arguing that I would be qualified to work in a level one trauma center. My goal is to work in level threes.

    If we're being honest, most of trauma is protocol driven or going to be flown over my head on a helicopter. For the remaining stuff that requires some serious thought... If I weren't confident I could always *gasp* pick up a phone. Wouldn't you guys like to be on the other end of that call for once?

    I just want to be the smallish town, old school doctor that loves his community, makes house calls, has a patient panel, sees his patients during emergencies, delivers their babies, and rounds on them in the hospital afterwards. And I find it interesting that all of the above can be done for the low price of five years of training (FM + ER and OB fellowships).

    Now, will I have to give up some respect and cash to pursue that dream? Probably. Will I know if 25 mg of drug A is better than 26 mg of drug B in African American females under age 65 below the level of the equator during the month of June? Probably not. But at some point... And I say this as a nontraditional student with a family... The pissing contest has to end or we'll all be going to school until we're 50 and too expensive to even employ.

    I'm not trying to take anyone's job. I'm just researching ways to make my dream (the way medicine used to be) work in areas where you guys don't want to live and where there is no help otherwise.


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  39. racerwad

    racerwad 7+ Year Member

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    I feel as though the reason has been explained to you numerous times already. Being a good ED doc an isolated, rural, resource-poor ED is difficult and requires more training than FM provides. Arguably, even the FM "EM Fellowship" is also not quite as good as a full-fledged EM residency. You could go the route you are describing, but you won't be as at it as an EM trained physician.

    What I don't understand is, if you want to be an ED doc so badly, why don't you apply for EM residencies instead of trying to find loopholes and workarounds?

    You say that you want to practice medicine as an "old school doctor" - have you actually tested the viability of your goals? Have you considered the reasons why there are so few "old school doctors" around? I know that you are unique and different from all the rest and that you can make it work when others have given up, but consider that the healthcare system in not the same now as it was when the school was not old.

    And, FWIW, you are trying to take an EP's job by trying to find a backdoor into working in an ED. You can't say for certain that your notion of life in a small town is not ideal for someone else, too.
     
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  40. Brigade4Radiant

    Brigade4Radiant 10+ Year Member

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    Yes you can work in the ED and with an ED fellowship you can be good. EM training is the best. Sure you can absolutely work in the ED. FM docs also can work in the OR (doing C-sections , colonoscopies or urologic procedures) they can also do OB, be a hospitalist, work in an ICU, do all peds or see all OB. Yes with FM you can do it all and it is a good specialty that gets a lot of flack.

    However you seem to be interested in ED so if you want to be great at what you do you need an EM residency just like if you want to be good at ICU work or peds works you need to be an intensivist or a pediatrician.

    I wouldn't say an FM is a better hospitalist than IM and they can do hospitalist fellowships.

    Here's the issue with FM. No other residency has such variation in curriculum and experience than FM. Some places teach you lots of procedures some places you get a lot of OB some places you get good adult and poor peds and vice versa. EM has less variation between programs which while there are top residencies in EM the gap between the top and the "bottom" in EM is much less than in Peds or IM which is why all EM programs are "good"

    FM is just way to broad of a specialty which is why they fit the bill as a general doctor in rural communities. The problem is that with more residencies and scientific advancement the standard of care has been raised too high. Which is why you don't see many FM doing OB. FM can also do Derm and some of them also do surgery and can remove gallbladders. Soon it will be ER and hospitalist positions that they will be pushed out which leaves them with clinic. Which is where FM is going.

    TLDR: Yes FM can do ER work the same as they can do hospitalist, intensivist, Derm, Urology and OB.
     
    Last edited: Apr 26, 2016
  41. Angry Birds

    Angry Birds 5+ Year Member

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    I strongly recommend it.

    Sigh. This is getting frustrating, but I can understand why for an outsider it's not as obvious as it is to an insider.

    It's like comparing an online degree to a regular one. The online degree holder will continue to make arguments, i.e. "I'm taking all the same classes, doing the same coursework, etc." but alas, the two will never be the same. Nowhere even close.

    Similarly, working in some random community ER will never, ever be anywhere close to going through an official ER residency.

    Let me try this another way...

    So, I completed my residency at a university hospital about two years ago. My first (and so far only) attending job has been in a small rural ER. I'm the only doctor in a 20-mile radius. The buck stops at me. In such a situation, I will tell you that I think my intense EM residency is the *only* reason I am able to manage.

    You only have 3-4 years of residency training. These 3-4 years must be very high intensity in order to make you strong enough to be a capable ER doctor, even at a small rural hospital ER like the one I currently work for.

    Had I done my 3-4 years of residency at this small rural ER (hypothetically speaking since it's not really possible), I would NOT be ready to be an attending at the same hospital... I had to go to an intense residency in order to be capable enough to handle this small ER by myself.

    This is because how much you learn is directly correlated to intensity of training. The intensity of a 3 or 4 year ER residency is very high, whereas at a small community ER is too low to make you a qualified ER doctor. You simply won't see enough complexity/volume of patients to adequately prepare you for when the sh** hits the fan, even in your small rural ER.

    Like I said, I currently work in a small rural ER. Most of the time, it's pretty chill. But, an hour or so every shift, sh** hits the fan, and then I thank my ER residency training for preparing me for this. I became immune to sh** hitting the fan, since it was always hitting the fan at the university hospital I trained at. The minute I'd walk into my shift, there would be ambulances lined up, patients in the halls, full waiting room, zombies everywhere. I needed that 24/7 for 3 years in order to deal with the 1 hour of that time that happens in my current shifts.

    I'm a new attending and trauma still scares the sh** out of me (even after doing my 3 years at a trauma center), so I don't know why you'd be so cavalier about it simply being "protocol driven."

    And no, they bring the patient to you first, and then you stabilize them--and have to keep them stabilized--until the helicopter folks come in to whisk your patient away. And, let me tell you, it feels like FOREVER in the heat of the moment. Moreover, those are the critical minutes in the patient's care.

    When sh** is hitting the fan and the patient is crashing, you don't have the time to rely on a phone call.

    Brother, I am currently working at the small rural ER, so I'd be on the same end of the phone call as you. And let me tell you, I can't just call another ER doctor somewhere and ask them what to do. First of all, that would be degrading. Secondly, I'd lose the respect of my entire ER. Thirdly, the ER doctor on the other end would be like WTF. Fourthly, it's just not done.

    As I've said before, I'm not trying to piss on your training, or say your plan is necessarily horrible. For you, it may be the most realistic option if you're dedicated to working in the ER.

    What I am 10000% against, however, is the idea that doing the same number of months in a community ER is somehow anywhere equal to or comparable to an ER residency. It's not. No way.

    And, for the record, me personally had I not matched in EM, I would *not* work in the ER ever. I barely feel capable enough even after doing an ER residency. I certainly wouldn't work in a small rural ER like the one I work in now... I'm it, dude. I got no specialists to call for help.

    I'd cut my losses and be a hospitalist.

    To me, your dream of working in some hick town seems antiquated... something that might have been fine in the 1960's, but things have changed now. BUT, that's just my personal opinion.
     
    Last edited: Apr 26, 2016
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  42. Cheese Whiz

    Cheese Whiz Doctora

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    I'm ER trained and boarded and I have to say I have the utmost respect for rural ED docs like yourself. Being single coverage at times in the city can be scary enough (I'm only a few years out, too). I moonlight at a far suburban freestanding and definitely have had plenty of anal sphincter tightening moments.

    For any ER role and definitely for the rural ED doc, you better be trained and confident in your ability to take a messy airway, throw in a quick central line, place that chest tube (after all, you're probably having to fly these patients), possibly throw in an art line, and manage the pressors and vent settings for any "protocol" trauma or sick patient to safely get them to the accepting hospital. If someone not boarded in EM feels confident enough to do those things then that's great. Otherwise, good luck as you will be held to the standard of care and same skill set expectations as the boarded physicians in any field you work.
     
  43. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    Art line? Where? In my rural hospital, we don't even have the ability to monitor one. And, even so, what are you going to do with it, which you would do with the peripheral BP cuff anyhow?

    (I know, you said "possibly"!)
     
  44. BlackDynamite

    BlackDynamite

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    I was under the impression that if a boarded EM guy wants an ED job, and there's not enough room at the table the FM guy gets let go.

    What happens at these rural places where there's a messy airway, etc. and no one to staff the ED? Does the ED shut down? Does the extra long ambulance ride kill more patients than a FM doc would? Especially if that FM guy has been working a double coverage place for a few years during stuff hitting the fan and has performed hundreds of procedures?

    I guess I have an interest in EM but I could live without it and don't want to be cornered into a specialty if I burnout like everyone else in the field. I want the ability to fall back on clinic, OB, normal hours etc. I certainly wouldn't jump into ER work solo cold turkey. If I wasn't comfortable during my training I just wouldn't do it. I want to have a job with normal hours but also be able to commute to a rural ER to help out, if I'm needed.

    If I'm needed... If I'm needed... If people are dying and the hospital can't find enough help... If I'm needed...

    I want a forty year career that allows me to be home at night with my kids, not a fifteen year one (because I'm sick of the hours, rich, and able to retire)







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  45. Fox800

    Fox800 That drug that starts with "d"... 10+ Year Member

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    Why do you fantasize about this so much? Match into EM or let it go. I think this thread is well done...or maybe burnt to a crisp.
     
  46. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    Dude, I admire your idealism. I do. I used to be the same way when I was a pre-clinical student. These types of posts pop up on here and are relatively frequent, albeit phrased differently:

    "I want to work EM a few days a week, but still do my FM clinic because that's where my passion lies."
    "I want to do EM, but have something to fall back on like urgent care or IM."
    "I want to work FM and practice the ministry of medicine, but I want critical care skills."

    For so many reasons, it really doesn't work that way in this day and age.
     
  47. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    You could always go for IM/EM, FM/EM, or EM/Peds combined programs.
     
  48. Vandalia

    Vandalia 2+ Year Member

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    Let me make a clarification that I think is perfectly obvious to EM physicians, but may not be for med students (or earlier):

    There are IM/FM physicians who work in an Emergency Department, but who do not practice Emergency Medicine.

    Few will deny that a significant fraction of the patients seen in an ED present with complaints that are best managed by a primary care physician. However, different groups handle this in different ways. Some believe that anyone presenting to an ED should be seen by an EM physician. Others make extensive use of NP/PA for "non-emergency" patients. Others hire full time IM/FM physicians to handle this population. Others hire IM/FM locums. Or some combination depending on the time of day.

    So there are certainly jobs where an IM/FM/Peds physician could work in an ED, but that is very different from being an EM physician.
     
  49. NERDY

    NERDY Member 10+ Year Member

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    There is a new FL program that is recruiting PGY 1 and 2 residents.
     
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  50. ordersol7

    ordersol7 2+ Year Member

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    Hey OP.
    I was in a similar situation to you last year except I extended my graduation and reapplied and matched to a less competitive specialty (IM) rather than matching into FM. I had low boards but passed both on 1st attempt and didn't take an LOA. Feel free to PM if you'd like any advice or if you'd just like to share. I'm not sure I could offer more practical advice than what the previous posters have already given but it may help to talk to someone who has been in a similar situation. Best of luck to you whatever route you take.
     
  51. BlackDynamite

    BlackDynamite

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    "This thread is annoying, but I can't stop reading it! Grumble grumble grumble."

    As for everyone else that has been helpful, thank you for the candid information. It has really helped me figure out my life. I'm sure other students in a similar situation have benefited even if they aren't commenting.

    Thanks for the offer, will do.




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