FM/EM combined residency vs. FM +EM Fellowship

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Makati2008

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I am currently at a crossroads at this time about what to possibly due as a residency when the time comes. I am currently having my medical school paid for by a rural hospital currently and EM(which I currently due as a PA is not on the list at this time). My CEO has said that FM with EM fellowship will be allowed and I am assuming that FM/EM or EM/IM combined(which I see a few listed on EMRA).

My questions are:
1.)Is there a huge difference in training in the EM/IM combined vs. FM + EM Fellowship
2.)With significant health problems is it worth it to due the FM/EM or IM/EM(which are five years long) that could possibly get worse during that longer residency
3.)From a family aspect do you guys think that it is worth the stress it will put on a marriage or family?

Sorry if these seems like run but running on about two hours of sleep.

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I am currently at a crossroads at this time about what to possibly due as a residency when the time comes. I am currently having my medical school paid for by a rural hospital currently and EM(which I currently due as a PA is not on the list at this time). My CEO has said that FM with EM fellowship will be allowed and I am assuming that FM/EM or EM/IM combined(which I see a few listed on EMRA).

My questions are:
1.)Is there a huge difference in training in the EM/IM combined vs. FM + EM Fellowship
2.)With significant health problems is it worth it to due the FM/EM or IM/EM(which are five years long) that could possibly get worse during that longer residency
3.)From a family aspect do you guys think that it is worth the stress it will put on a marriage or family?

Sorry if these seems like run but running on about two hours of sleep.

You will probably get better answers to this on the EM forum but this is as good a place as any for this question. Here's my take on it (I'm IM, not EM FWIW).

1. Yes there is, primarily the fact that FM + EM fellowship doesn't provide you board eligibility by ABEM. While you may still be able to get a rural ED job with that training, the trend is moving toward hiring ABEM certified EPs to staff most EDs. While you may look at that particular hospital now and see it staffed with FM and IM folks, in 5-10 years (when it will be an issue for you), that may have changed significantly.

2 and 3. Only you can really answer those questions. Since you currently work in an ED, you probably know how stressful working there can be. And in residency it will be even more so simply because you'll probably be in a busier ED. But every residency (IM, FM, EM, Peds, whatever) is going to be stressful in one way or another. As to the time aspect, that will also depend on you and your family.
 
think long term here... If you want to be an EM doc, do an EM residency. Period. A FM residency, even if you do some fellowship will leave you less qualified, not board eligible, and restricted in your future EM job opportunities. If your current program won't allow you to go EM, then get out of that program, take out student loans to pay for medical school and then feel comfortable knowing that an EM doc makes plenty of money to pay those loans back.
 
think long term here... If you want to be an EM doc, do an EM residency. Period. A FM residency, even if you do some fellowship will leave you less qualified, not board eligible, and restricted in your future EM job opportunities. If your current program won't allow you to go EM, then get out of that program, take out student loans to pay for medical school and then feel comfortable knowing that an EM doc makes plenty of money to pay those loans back.

Believe me I have. I have thought long and hard about my options. I predict(like one of the previous posters) within 10 years the area I live in will be EM docs running the show and not the FM/IM docs.

I honestly cannot (rather would not) break this contract with the facility that I am with. They have treated me like family, love the nurses, and the other providers(Physicians) have each others backs. They have also paid me very very well as a PA here and I am being told they have "plans" for me.(I am assuming Chief of Staff eventually).

So I am looking at it from a different spin->Apply to the LSU combined residency as well as others of course and hope that I match at a combined residency(I look at it like this- If I did EM as a DO I would have a four year residency then there would only be an additional year tacked on to finish the IM component in theory). Money also is not that important to me if they paid me a little bit more than I was making as a PA then I would be fine with the amount but it is more so that I am comfortable with EM and I would at least like to practice it part time(If I match at a combined I would do IM or FM the majority of the time while trying to work at the local level one one day a week that I would have off here.-> The doctors here work technically 3.5 days a week.)

Thanks for the reply.
 
as a DO the fm/em options seem like a no brainer. em is 4 yrs and you get both for 5. this way you could start your career in em and gradually transition to fm/admin with a few em shifts/mo over time.
 
At some point, you have to be a bit selfish and look at the long term financial implications of this decision too, and leave aside emotional loyalty to a nebulous entity out of a sense of obligation.

A 3 year EM program prepares you for a job making an average of $220K per year. If you do a combined program, you lose 2 years of income at that salary. Assuming you make ~50K as a resident, that is a net loss of $340,000.

Is this decision worth the loss of $340k?
 
At some point, you have to be a bit selfish and look at the long term financial implications of this decision too, and leave aside emotional loyalty to a nebulous entity out of a sense of obligation.

A 3 year EM program prepares you for a job making an average of $220K per year. If you do a combined program, you lose 2 years of income at that salary. Assuming you make ~50K as a resident, that is a net loss of $340,000.

Is this decision worth the loss of $340k?

Honestly it's not that big of a deal about money(if you see my previous post I made between 160-180 as a pa and I don't work that hard IMHO when comparing to the manual labor my dad does) and if it was I would have stayed a pa strictly due to the amount I was
Making. Also since I am a do like emed mentioned my residency would probably be four yrs anyway.

So to answer your question it's not about the money but moreso the love of emergency medicine which I can satisfy being fm/em

Thanks for your replies
 
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