Originally posted by Jackson 01
I understand the concept of wanting to staff all EDs with properly trained physicians. However, does that always have to mean a 3 or 4 year EM residency?
Yes, the same as a cardiologist should have three years of IM training followed by a fellowship. Your career is never defined by how you handle the easy, day-to-day stuff. It
is defined by how you handle that unusual presentation or that rare disease/disorder.
In many rural areas the staffing of the EDs is shared by local GPs who worked fewer, but extended hour shifts. The money is just not there to hire EM trained physicians
Well o.k., let's hire anyone who will take the job. I'm sure there are plenty of nurses and scrub techs who would love to take a crack at performing lap cholys.
and the patient population is significantly different.
Different than where? I'm training at a school with a mandatory 2.5 year, longitudinal, rural medicine / family practice clerkship. I can tell you from experience, people are people (so why should it be...
😀 )
The idea of a combined residency is a good thing for those who wish to practice rurally so they can receive standard training. For those who say "pick one or the other and stay with it!" have obviously not had any experience in rural medicine.
Holy generalization Batman!
And what bovine scatology to boot. The
only case of Hurler's syndrome I've ever seen was in a rural clinic. In the same clinic I've also seen anacephalic miscarriages, chemical burns (lots o' trauma), as well as old fashioned ACS (farmers tend to cook with whole butter and cream). Unfortunately, I've also seen the woman thrown from her horse with the fractured scapula (confirmed by x-ray in the FP clinic) being sent with her husband in a POV to the trauma center 40 minutes away - no spinal immobilization and no stabilization by the good ol' GP. I've seen more sexual assault, drug use and domestic violence flat out ignored, because of
who the patient / victim / aggressor was in (to) the community than I care to think about, and I had to correct one board certified FP when he began running a code with two amps of sodium bicarb...
Rural docs have to truly be a Jack of all trades because they don't have the support of a larger area.
Gee, earlier in this thread a supporter of the combined residency listed the EP as the shallow jack of all trades...
And often these areas need a trained FP doc just as much if not more the a solely EM trained physician.
Yep, they need both. The EP to be in the ED, running the EMS system and evaluating emergent patients, treating those he/she can, and appropriately transferring those who need more specialized care. The EP is uniquely trained to make those decisions with a high degree of sensitivity and specificity. The FP is not. However, the FP is vital as a primary care provider in many settings. They can provide preventitive health care, chonic disease management, and basic, non emergent, health care to a community.
There is a shortage of trained EM physicians today.... there will continue to be a shortage as the demand grows.
Why is the idea of a FP / EM trained doc so blasphemous to the EM die hards?
For the same reason it is so blasphemous to OB/GYNs for FP to manage high risk pregnancies, or to surgeons for FP to perform surgery under general anesthsia. They are simply not trained to do so. As stated above, for 95% of the cases the FP will do fine, but that 5% deserve better. Even more important, the FP is very unlikely to be able to define that 5%.
You guys don't want to practice in a town of 8,000 so why not correctly train the guys who do?
Again with the generalizations. Why is it that FPs believe they are solely "blessed" with the vocation to practice in rural areas?
- H
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