FM working in EM (EM fellowship?)

[deleted1227891]

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[Lexdiamondz]

BCEM here. My 2c - you may have some enhanced skills in emergency medicine but it won't appreciably increase your marketability. Jobs that want EM trained physicians won't care that you did a fellowship since they need you to be board-eligible. Jobs that accept FM trained docs won't care since they're desperate.

Your prior training in general surgery is somewhat helpful, but 2.5 years of gen surg and a family medicine residency does not an EM physician make. EM is it's own specialty with it's own skillset and, more importantly, it's own mindset that you aren't really gonna learn with just a couple electives and a non-accredited 1 yr fellowship. You have to ask yourself if you're comfortable potentially being responsible for managing conditions and pathology that you were never trained for.

 

[deleted1227891]

Jobs that want EM trained physicians won't care that you did a fellowship since they need you to be board-eligible. Jobs that accept FM trained docs won't care since they're desperate.

This is along the lines of what I was thinking...

 

[VA Hopeful Dr]

This is along the lines of what I was thinking...

I will say from a skills perspective, its probably a good idea. Even if you use all of your elective time to do ED rotations we're likely talking 6 months of less of ED time across your whole residency.

 

[automaton.]

Looking for some advice

The long story here is that, I was a former General Surgery resident who was approximately halfway through his third year who realized that this was a miserable life choice for and also did not feel I was a good fit in the program. I ended up taking some time off and he may consider leaving medicine altogether. When I decided to come back there was an open position at a nearby residency program in family medicine who was willing to give help me. While I was initially not thrilled about switching into family medicine I did so due to learning the various options that I may have afterward. At this time I am in my second year of family medicine residency and looking to work in an urgent care and emergency department setting. I know many of you reading this are already saying that I should not be anywhere near the emergency department as a family medicine doctor but I do know some places will hire a non-boarded EM docs out in more rural areas. Also with my formal training I was primarily at a level 1 trauma center when I was in general surgery so I was exposed to a decent amount of trauma at that time.

Since being away from surgery, I do feel that some of those skills have atrophied some. My main question now is it worth looking into the non-accredited emergency medicine fellowship for family medicine residents?

I am well aware this will not make me a board certified emergency medicine physician, but would there be any utility in this to broaden my skills and perhaps make me more marketable to the facilities that will take family medicine doctors in their emergency department?

I plan on completing all of my electives in emergency medicine, ICU, possibly anesthesia, possibly Peds-EM

TLDR: I completed 2.5 years of general surgery and switched to family medicine and hope to work in the emergency department, is it worth it to look into the non-ACGME emergency medicine fellowship for skills and marketability?

You probably don’t need the fellowship but it’s nice to have on your resume. Moonlight as a resident. Some places will let you shadow in the ED which you can use as an elective. I’m seeing more previously EM-only places opening up to FM/IM. Mastering your IM skills/knowledge is probably more useful than your surgery skills. I work with a few docs with similar surgery backgrounds as you and they themselves avoid procedures. Most of EM is straight up medicine unless you only work in the trauma or peds pod.

 

[Lexdiamondz]

I'm even toying whether to try and apply EM after I finish FM so I could really work anywhere. If I could go back knowing what I know now I probably would have applied the dual EM/IM or EM/FM programs.

I just feel the best when I can try and be a generalist. Even when I was in surgery I was going to apply critical care so I could have that skillset in addition to operating.

Is it worth trying to

A.) Go for the 1 year non-accred EM fellowship.
This would allow me to do inpatient, outpatient, urgent care and more marketable to some hospitals for EM but may not make a huge difference and lose out on a year of attending

B.) Apply to EM residency after FM. Losing out on 2-3 years of attending level salary and going back for ANOTHER residency as a PGY-1 or PGY-2
Could again do inpatient, outpatient, urgent care, emergency rooms without barriers and may even be able to cover some ICU

C. Finish FM and continue with shadowing in EM, courses, ATLS, seminars etc and my skills will still grow
Do inpatient, outpatient, urgent care and hospitals for EM that will hire

Serious question - if you weren't happy potentially just doing inpatient + clinic, why switch to an FM residency? As a generalist I can understand wanting to have a broad and versatile skillset, but it is truly impossible to be an excellent inpatient, outpatient and acute care physician at the same time without going through an ungodly amount of training, and then subsequently working an unreasonable amount of hours in each setting to keep your skills from atrophying. It's almost impossible to do it all, and you're going to waste a fxckton of time and money trying.

Bouncing from surgery to FM to maybe EM hints that there may be a deeper issue here than just lack of job satisfaction. These are three fairly different specialties with only marginal overlap, and you're now looking at a total of 7 years of postgraduate medical training just to do the same job as an ER doc from a 3 year residency.

If you're hellbent on doing ER then I'd look into switching into an ER residency now...but you're going to have a hell of a difficult time explaining to any PD why they should gamble on a resident who has jumped ship from two other programmes in two different specialties.

Truthfully, I think you need to do some soul-searching before you make any more career decisions.

 

[Jack_of_All_Trades]

I have a very similar path (GS --> FM) with hoping to work in the ED. I was going to consider the fellowship just for comfort more than anything (intubations, tubes, LPs, ACS type emergencies etc)