FP working in ERs??

[Gr42]

---

Members don't see this ad.

I'd like to know if Family physicians who are ER certified get paid the same as docs who have completed an Emergency Medicine Residency?

 

[Jeff698]

I'd like to know if Family physicians who are ER certified get paid the same as docs who have completed an Emergency Medicine Residency?

Interesting question. If you trained in FM long ago and became board certified in EM through the practice track that has been closed for some time now the answer is maybe. You're pay will likely be the same as a residency trained EP working the same hours in the same department. You're options for finding employment in desireable locations, however, will be significantly reduced.

If you're training in FM now, you're pay will be much, much less than your EM trained colleague; essentially it will be zero since you will not be eligible for board certification in EM.

Take care,
Jeff

 

[FoughtFyr]

I'd like to know if Family physicians who are ER certified get paid the same as docs who have completed an Emergency Medicine Residency?

I wasn't going to touch this as those who know me IRL think I have an "anti-FP" bias. I do, but it comes as the result of attending a medical school where FP was "forced" on each student, and the political agenda of the AAFP ran rampant. I was often told not to go into EM but rather FP. When I started school those giving this counsel said they were certain the "practice pathway" would be reopened. When that lawsuit (finally) settled, they advised an FP EM fellowship. To quote Col. Potter - "HORSEPUCKY!"

There is no "ER Certicfication" for FPs that is accepted by the ABEM. (And given that you are a newbie you should know that some people here might get offended at the term "ER", it is an "Emergency Department" with many rooms. The specialty is "Emergency Medicine" or "EM" and we are "Emergency Physicians" or "EP"s). While the AAFP does offer fellowships in EM, these do not lead to board certification by ABEM. There is currently no pathway, other than an EM residency, to become board certified in EM.

Does board certification matter? Yes and no. Certainly there are academic papers that suggest the residency trained EP is less likely to be sued than the non-EM residency trained EP. And this has been noticed by med-mal carriers. Many have begun refusing to cover non BE/BC EPs. But, for now, the demand for BE/BC EPs is greater than the supply. So yes, you can find work as an FP in smaller community facilities. It would be nearly unheard of now for an FP to be hired into academic or tertiary centers (but some tenured physicians might still remain).

What you should realize is that this career path (an FP practicing EM) might be severely limited. First, should you be sued and lose, or even have the appearance of liability, it is doubtful your med-mal carrier will allow to continue to practice EM (of course, for an FP the same is true of OB). Even if you don't suffer a suit, at any time, the hospital you are affiliated with can switch EM groups. These buy-outs are not infrequent, and it is unlikely FPs would be kept on. Lastly, it is not only your med-mal carrier, but that of the hospital where you work that might "squeeze" you out. For example, where I trained one of the hospitals is "home" to the FP residency. Their level-II trauma canter, 40K visit ED was staffed with a mix of FPs and EM-trained EPs. The residents also rotated through. After an unsuccessful lawsuit, the hospital's med-mal carrier threatened to drop coverage if the ED was not converted to all BE/BC EPs. An EM corporate group was in place within a month. All of the residency trained EPs were kept, and all of the FPs were let go. Some had 10+ years in the department and were quite skilled. When I left, the hospital was still negoiating to allow the FP residents to continue their EM rotations.

Basically, you should realize that EM is a specialty, just like surgery, cardiology, rheumatology, etc. And while an FP knows something of the conditions we evaluate and treat, their methodology and focus are completely different from ours. And, given the AAFP "practice pathway" lawsuit, and the sideline view of the onoing struggles between OB and FP, it is unlikely that FPs will find a wellspring of support for maintaining a presence in EM.

Bottom line, if you want to do EM, do EM.

Just my $0.02 worth (actual cash value $0.005)

- H

BTW - see the similar thread in the FP forum

 

[NinerNiner999]

FoughtFyr brings up some good points. From what I have heard, FP's can often make the same salaries as PA's, but don't touch EM physicians in compensation. Then again, if you like urgent care medicine, FP's are well suited for UC clinics or the proverbial "Doc in the Box."

 

[Gr42]

Thank you very much for all of your input in this matter. I was just curious sfter attending a residency fair held during a conference las weekend. Family practice physicians made sound like if they wold be able to practice anywhere; however, they never mentioned anything about differences in compensation. Once again thanks to all of you Emergency Physicians and residents for your answers.

 

[Sessamoid]

Thank you very much for all of your input in this matter. I was just curious sfter attending a residency fair held during a conference las weekend. Family practice physicians made sound like if they wold be able to practice anywhere; however, they never mentioned anything about differences in compensation. Once again thanks to all of you Emergency Physicians and residents for your answers.

It will be difficult to find jobs plentiful even in rural areas in the future. If you have any intention of ever living in a major metropolitan area, then realize that FPs are already completely absent from EDs in new hiring.

 

[NateatUC]

To quote Col. Potter - "HORSEPUCKY!"

I'd just like to give credit for the M*A*S*H* quote. Strong work!

 

[FoughtFyr]

It will be difficult to find jobs plentiful even in rural areas in the future. If you have any intention of ever living in a major metropolitan area, then realize that FPs are already completely absent from EDs in new hiring.

There is an "on point" discussion on the EMED-listserv right now. Two quotes:

1. "I believe there is a move afoot among medium size hospitals to limit privileges among new applicants to those who have completed an EM residency. ABEM certification will no longer be sufficient. Board certified EM physicians without EM residency have effectively been shut out of academic positions for years."

2. "When we won our contract five years ago, the hospital specifically stated that all ED docs had to be "residency trained" and must be boarded in five years. They had ABEM non-residency trained physicians working there. When they sent out their RFPs, they specified residency trained. One of the reasons we got the contract was that none of the CMGs would put that in writing, though they paid lip service to it. The hospital did not want anyone that was ABEM certified but not residency trained. This was a hospital about 90 minutes out of Chicago, with a census of 14,000 in a town of 19,000. I am not editorializing, I am just letting you know the changing market for EM."

These folks are talking about the exclusion of ABEM boarded but non-residency trained physicians. Needless to say, the market would be even worse for FPs.

Sorry, but I think the FPs you spoke with were trying to tell you what they thought you wanted to hear.

- H

 

[roja]

The vast majority of hospitals are tyring to phase out EMP's.. even lower volume ED's (as small as 15,000), probably to cover thier tails...


FP is not EM. period. You could probably still find work in really really small towns that can't attract an EMP.

FP's don't belong in the ED anymore.... they don't have the training or the skills... (I don't mean this in a mean way...I have heard HORROR stories)

Older EM certified attendings are board certified because in general, they only do EM and are thus qualified. However, since EM residencies have been around so long, its a closed path.

 

[Sessamoid]

Older EM certified attendings are board certified because in general, they only do EM and are thus qualified. However, since EM residencies have been around so long, its a closed path.

Except apparently in Florida. 😡

 

[Apollyon]

The vast majority of hospitals are trying to phase out EMP's.. even lower volume ED's (as small as 15,000), probably to cover thier tails...

What does this mean - or is this a typo? Aren't they trying to phase in EMPs?

 

[Seaglass]

I think she meant FMP's

 

[roja]

it was a typo. 😀 and some reason all the responses weren't coming up on my threads... curious.. 🙂


I meant FMP's. 🙂

 

[jonahhelix]

During my outpatient Family Practice clerkship, I was sent to a small, way underserved, town to work with a practice that also contracted to cover the local ED. A certain number of shifts were required by each practice doc, and the ED work was included in their compensation package.

When I asked about whether the hospital was looking to staff the ED with EPs, I was told that they couldn't afford it. Given their arrangement with this practice - paying maybe 200k per year, no benefits - I can see why the switch would seem prohibitive. Not to mention, how many EM BC/BE-ers would want to work in Podunk for low-end compensation?

While I personally don't like the notion of FPs staffing EDs, I wouldn't want to see this sort of ED closed just because EP-staffing was not possible. Something tells me that rural/underserved medicine will always be a little different than city/ivory tower medicine.

The FP programs probably have a better sense of this dynamic than we do, so maybe - as much as we don't want to hear it - they weren't just blowing smoke?

 

[FoughtFyr]

During my outpatient Family Practice clerkship, I was sent to a small, way underserved, town to work with a practice that also contracted to cover the local ED. A certain number of shifts were required by each practice doc, and the ED work was included in their compensation package.

When I asked about whether the hospital was looking to staff the ED with EPs, I was told that they couldn't afford it. Given their arrangement with this practice - paying maybe 200k per year, no benefits - I can see why the switch would seem prohibitive. Not to mention, how many EM BC/BE-ers would want to work in Podunk for low-end compensation?

While I personally don't like the notion of FPs staffing EDs, I wouldn't want to see this sort of ED closed just because EP-staffing was not possible. Something tells me that rural/underserved medicine will always be a little different than city/ivory tower medicine.

The FP programs probably have a better sense of this dynamic than we do, so maybe - as much as we don't want to hear it - they weren't just blowing smoke?

Unfortunately, for the FP who desires this sort of work, the medical liability is no different in that ED than in others. The med-mal carriers know this and very often will effectively "shut down" the ED by refusing coverage. It is not that FPs "have a better handle on this", it is simply that they are not trained to handle it.

BTW - These same small towns are often lacking in cardiologists. Should FPs be allowed to caths because they want to and there is a need? EM is a specialty, FPs cannot do it because they "want to" and there is a need...

- H

 

[roja]

The impression that was given was that FP's can practice in ANY ED. This is not true. Yes, you can work in exceptionally small ED's. That is not the vast majority of ED's.

You shouldn't close these ED's, nor is anyone really advocating this.

 

[jonahhelix]

Unfortunately, for the FP who desires this sort of work, the medical liability is no different in that ED than in others. The med-mal carriers know this and very often will effectively "shut down" the ED by refusing coverage. It is not that FPs "have a better handle on this", it is simply that they are not trained to handle it.

GTW - These same small towns are often lacking in cardiologists. Should FPs be allowed to cath because they want to and there is a need? EM is a specialty, FPs cannot do it because they "want to" and there is a need...

- H

Trust me, we are all on the same side, generally, on this issue. However, I am not so bold to intimate that emergency care (vs. EM, the spec) is as inaccessible to FP's as cardiac cath. Such an analogy is hyperbolic at best, factious and inflammatory at worst.

ANY physician (and layperson, for that matter) can provide the best care he/she is trained to in an emergency situation. While FP's will NEVER cath a patient, they are residency-trained to assess and treat a wide spectrum of illness/injury that presents to the ED. However, not all FP's have shown awareness of their limitations, nor are they well-trained to do so (re: ED work) during their residency. I believe this is the crux of the FP in the ED issue.

Still, I maintain that there are going to be circumstances where non-EM-trained physicians are going to be needed to staff EDs. How we help "train" and work with these docs will be crucial to patient care as a whole.

I know we are fighting for validation of our specialty, but I think there are tons of reasons to support EPs and EM that don't settle for directing venom at FPs and their desire to care for patients often ignored by the rest of medicine. (I know I'm not willing to work in an ED for $80k while seeing few interesting cases ever....)

Still, I'm sure having a variety of tactics serves a purpose, so here's to everyone for fighting our fight however you do it. 👍

 

[emtp2pac]

"(I know I'm not willing to work in an ED for $80k while seeing few interesting cases ever....)

Still, I'm sure having a variety of tactics serves a purpose, so here's to everyone for fighting our fight however you do it. "

pa's are lining up to cover these small er's( < 10 k pts/yr) and are willing to work for 80 k for 7 24 hr shifts a month. lots of tiny er's around the country are staffed this way with md backup available by phone as needed.
in my experience although these sites are low volume they tend to be relatively high avg acuity with many pts stabilized and shipped on to larger centers for more definitive care.

 

[FoughtFyr]

Trust me, we are all on the same side, generally, on this issue. However, I am not so bold to intimate that emergency care (vs. EM, the spec) is as inaccessible to FP's as cardiac cath. Such an analogy is hyperbolic at best, factious and inflammatory at worst.

ANY physician (and layperson, for that matter) can provide the best care he/she is trained to in an emergency situation. While FP's will NEVER cath a patient, they are residency-trained to assess and treat a wide spectrum of illness/injury that presents to the ED. However, not all FP's have shown awareness of their limitations, nor are they well-trained to do so (re: ED work) during their residency. I believe this is the crux of the FP in the ED issue.

Still, I maintain that there are going to be circumstances where non-EM-trained physicians are going to be needed to staff EDs. How we help "train" and work with these docs will be crucial to patient care as a whole.

I know we are fighting for validation of our specialty, but I think there are tons of reasons to support EPs and EM that don't settle for directing venom at FPs and their desire to care for patients often ignored by the rest of medicine. (I know I'm not willing to work in an ED for $80k while seeing few interesting cases ever....)

Still, I'm sure having a variety of tactics serves a purpose, so here's to everyone for fighting our fight however you do it. 👍

Well, we can agree to disagree. I do not find the example hyperbolic, factious or inflammatory. I am not "fighting" to define my specialty, it is defined by the ABEM. I know that you have yet to begin your EM training, and I VERY sincerely wish you well, but please allow me to express the belief that after a bit of time in an ED with "off-service" rotating residents, your views will change.

I do not doubt that an internist, or FP, or good old fashioned GP could fairly adequately handle 80% of what walks in the door. That said, they could handle 80% of what walks in a cardiologists door, a neurologists door, even a surgeons door. What defines EM is a different approach to a patient than in other areas of medicine. This approach, including the rapid assessment for and early diagnosis of life threats, is central to our practice.

I'll give you an example, I have seen many "off-service" residents spend nearly an hour with a patient, developing a substanial differentials, before getting tests such as an ECG or CXR on patients with "resolved" CP. Now, according to the "best practice" for internists and FPs, this is perfect. By EM standards, it is not. Another area of "disaster" I have seen frequently is the ill-preparation for critical transfers by EDs manned by FPs. Our helicoptor regularly picks up patients for whom the basics steps to prepare for transfer have not been taken. Why? Because that skill is not routinely taught to FPs and internists!

Now, I can appriciate that FPs genuinely want to help. But, for the patient who enters the ED en extremis, an FP manned ED is as dangerous as a FP manned cath suite. People deserve better, and as has been pointed out here, better exists. EM trained PAs for example...

BTW - my post did not "spit venom" at FPs. I was merely stating the reality of medical malpractice insurance today. FPs are often not able to be covered. That is fact, not venom. At places they are currently covered, the coverage can berevoked at any time, also factual. EM Corporate Group buyouts of practice contracts, even in small rural EDs also occur (you said yourself an FP group currently held the contract). FPs are not generally retained in that event. These are facts, not venom. If I "sounded" upset it was not about FPs in the ED, policies and pressures in place already are rapidly extincting this, but in the deception used by many recruiting new FPs. I was lied to repeatedly during medical school regarding FPs' role in EM. I was educated enough elsewhere to detect the deception. It concerns me when I hear about similar devices being used to recruit new medical students to FP who then come here to "check the facts".

- H

 

[Seaglass]

I am unfamiliar with any FMP's proficient in the placement of a chest tube.

 

[docB]

ANY physician (and layperson, for that matter) can provide the best care he/she is trained to in an emergency situation.

But we're not talking about being the man on the street. We're talking about being the Attending in an ED with a duty to act and expectation of EP level care.

 

[stoic]

I am unfamiliar with any FMP's proficient in the placement of a chest tube.

You should come hang out in the middle of kansas then! Pretty much all the ED's outside of KC and wichita are staffed by a majority of FP's and internists. And they do place chest tubes. We're talking about ER's that see 20-30k a year.

Not saying it's good or bad, but I do think that things are going to be slow to change out here in the middle of nowhere. Maybe I'll be the first BC emergency physician back in my home town 😀.

 

[FoughtFyr]

You should come hang out in the middle of kansas then! Pretty much all the ED's outside of KC and wichita are staffed by a majority of FP's and internists. And they do place chest tubes. We're talking about ER's that see 20-30k a year.

Not saying it's good or bad, but I do think that things are going to be slow to change out here in the middle of nowhere. Maybe I'll be the first BC emergency physician back in my home town 😀.

Here are the ACEP and AAEM leadership responses to a similar question posed on the EMED list:

"Dr. Murphy:

As a leader in ACEP, I believe I have spoken more than enough on this issue
to represent ACEP's over 22,000 members. Further, the ACEP Council in 1997
spoke very clearly when they decided to limit ACEP membership to EM
residency trained and/or recognized EM Board certified EPs.

Time, business practices, and an increasing supply of EM residency graduates
will eventually solve the fundamental issue and that direction is also very
clear.

How well those without such credentials fair in the new EM world may very
well be outside of everyone's control, but in my opinion they are making
things worse for themselves. So, I have suggested a new approach: To join
with the main stream of EM, draw the line in the sand, declare the future of
EM as a specialty to be practiced by EM residency trained physicians, and
give up the notion that "any primary care training is adequate (or even
desirable)". Such notions (which as previously noted are now increasingly
being ignored by hospital medical staffs and liability insurers) weaken the
specialty. It also places the livelihoods of those without such credentials
at risk by forcing hospital medical staffs and liability insurers to use
other criteria (such as EM BC) as a litmus test without consideration of
experience (i.e. the grandfather concept).

Recent efforts to achieve regulatory recognition of non-standard EM BC is
but one more example of an ill-conceived effort that only forces the same
medical staffs and liability insurers to further limit their criteria since
non-standard EM BC continue to espouse open access to the practice of EM.

These are policy and political issues. Common sense will, perhaps
unfortunately, increasingly take a back seat no matter what any of us
believe.

Todd B. Taylor, MD, FACEP
Vice-Speaker, American College of Emergency Physicians
Vice-President for Public Affairs, Arizona College of Emergency Physicians
[email protected]"

"Mike,
The arguments have been rehashed several times on this list and that
is why you see little in the way of response. The discussion really is not
a discussion but just a statement of beliefs that will not be changed. No
matter what we say those who are not certified will continue to argue that
they deserve some kind of recognition as equals. Those who state things
like 'Rosen was not residency trained so I don't need it either' ignore the
fact that Rosen himself would never endorse a non-residency pathway in this
day or in the past 2 decades.
AAEM has always been clear on this matter. Our mission statement
created in 1993 defines an EM specialist as one who has achieved legitimate
board certification. Despite the continued ignorance by the "other side" of
the literature it is clear that EM residency training and board
certification do make a difference (again go to our web site for the
evidence). We have actively fought for this standard and continue to do so
as witnessed by Dr. Kazzi's, our President, efforts to address the Florida
situation.
There is no need for creative solutions, the practice track closed
in 1988, the Daniels suit failed, the back door attempts such as in Florida
need to be dealt with. Unfortunately this diverts AAEM resources from
helping the individual docs who are affected by the corporate practice of EM
but we need to keep true to the mission statement and be active in these
matters.
Bob McNamara"

- H

 

[Derek]

"the back door attempts such as in Florida need to be dealt with. "


I have heard Sessamoid make reference to this FL issue as well, but I am still unclear as to what this is about.

Does anyone have some insight into this?

 

[FoughtFyr]

"the back door attempts such as in Florida need to be dealt with. "


I have heard Sessamoid make reference to this FL issue as well, but I am still unclear as to what this is about.

Does anyone have some insight into this?

Do a thread search, this was discussed extensively in this forum, but the basics are that the AAPS, a physicians group, fought with questionable success to allow the emergency medicine section, the AEP, to issue "board certifications" in emergency medicine. This is in contrast to those issued by the ABEM, which is the generally recognized body for doing so. The AEP does not require completion of an EM residency for board certification. Per their website (at:http://aep.org/myths.asp) "AEP Fellowship Criteria include practice and/or teaching of Emergency Medicine for a minimum of 60 months total; and accumulated 7,000 hours total in the practice and/or teaching of Emergency Medicine; and accumulated 2,800 hours consecutively within any 24-month period of time; confining one?s practice to Emergency or Urgent Care Medicine; accumulation of 150 hours of CME credit within the previous three years of practice that is acceptable to the Fellowship Committee; and a demonstration of commitment to Emergency Medicine by active involvement in various ways."

Needless to say, this is a bit distressing to EM trained EPs. Currently Florida is the only state to accept the AAPS "boards". EM is not the only specialty that AAPS claims to "board" but it is the one with the greatest disparity between the generally accepted board standards and those of the AAPS.

- H

 

[docrjay]

"Now, I can appriciate that FPs genuinely want to help. But, for the patient who enters the ED en extremis , an FP manned ED is as dangerous as a FP manned cath suite. People deserve better, and as has been pointed out here, better exists. EM trained PAs for example..."
-- post by FoughtFyr


Does this imply then that EM trained PA's are better then FP's? 😡

 

[FoughtFyr]

"Now, I can appriciate that FPs genuinely want to help. But, for the patient who enters the ED en extremis , an FP manned ED is as dangerous as a FP manned cath suite. People deserve better, and as has been pointed out here, better exists. EM trained PAs for example..."
-- post by FoughtFyr


Does this imply then that EM trained PA's are better then FP's? 😡

In emergency medicine? Yes, absolutely. In general practice medicine, no, not at all.

Sorry.

- H

 

[deleted6669]

"Now, I can appriciate that FPs genuinely want to help. But, for the patient who enters the ED en extremis , an FP manned ED is as dangerous as a FP manned cath suite. People deserve better, and as has been pointed out here, better exists. EM trained PAs for example..."
-- post by FoughtFyr


Does this imply then that EM trained PA's are better then FP's? 😡

no doubt about it. an fp doc without specialty training in em has maybe 6 wks as a med student and 3 months as a resident. wow, 18 weeks of em training in their entire lives. a typical em pa was a medic or er rn before pa school and spent all of their electives on em related courses. for example I was an er tech for 5 yrs then a medic for 5 yrs before becoming a pa. I had 22 weeks of em in pa school( general/peds/elective) in addition to 5 weeks of trauma surgery, not to mention acls/atls/pals and all cme ever since graduation taken in em. granted an fp doc who expresses a serious interest in em and takes lots of extra coursework/electives has good preparation but a typical fp residency grad right out of residency? I would take the em pa hands down every time for the care of myself or my family(and have on several occassions).one of my current responsibilities as an em pa is to precept fp residents r1-r3 in the er. many of the interns can't suture. many of the r2's and r3's don't know how to do regional blocks or reduce fxs or do facial lac repairs on kids.....recently I was precpting an r3 who was totally out of his depth working up an elderly pt with chest pain...yes, there are great fp docs working in the er, but they made themselves great. they didn't get that from basic fp residency training.

 

[bulgethetwine]

An Interesting compromise has arisen in Canada -- a hybrid pathway available to family practice residency graduates. They take an extra year of residency training in emergency medicine, kind of like an EM fellowship but without the academic focus. Instead, they focus on the nuts and bolts of working the ED, probably not unlike months 18-30 of a typical PGY 1,2,3 residency. AFter that, they apply for a special designation -- not equivalent to a fully trained EP, but a special designation nonetheless.

They are then permitted to work in emergency departments EXCEPT Level I trauma centres (i.e. underserviced areas). It is an interesting approach brought about in part because it is harder to train sufficient EPs in a country where there are fewer urban centres. It has also resulted in a higher proportion of graduates choosing FP as a primary resiency because they don't feel as if there is a path of no return if they don't like/aren't adequately stimulated by FP (there are similar one year 'extra' years available in OBGYN, Anesthesia, and Sports medicine).

Even more interesting is the study done by the Canadian Medical Association exhibiting that 3 years out of the program, there was no significant difference in performance, malpractice, etc. between those who were fully EM certified vs. the FP + 1 configuration.

The hospitals are happy because they have enough (well, closer then they would be otherwise) docs in their ED.
The EM trained EPs are happy because their Level I job opportunities are protected.
The FPs are happy because they feel they got the best of both worlds: A general practice background with some extra training to cover the 20% of the cases (to borrow the stat from the above posts) they wouldn't likely see in an FP residency.

I am sure its not perfect, but it seems to be a better-than-average solution as far as stop-gap solutions go.

Of course, full disclosure would dictate that I add I am Canadian and still chose to do my residency south of the border in EM! 😀

 

[southerndoc]

Thank you very much for all of your input in this matter. I was just curious sfter attending a residency fair held during a conference las weekend. Family practice physicians made sound like if they wold be able to practice anywhere; however, they never mentioned anything about differences in compensation. Once again thanks to all of you Emergency Physicians and residents for your answers.

Some FP program directors might make this claim as family medicine has had a tremendous decline in the number of applications received over the past few years.

 

[southerndoc]

Why would they exempt them from working in a level I trauma center? One would think a level I trauma center would have available nearly every specialty as a consult service. In fact, the majority of level I trauma centers are teaching institutions with in-house consultant services.

I would argue that FP's could work in level I or academic centers that do not have an EM residency, but NOT in rural areas. In rural areas, there is no consult service readily available and EM physicians must manage any and everything that comes through the door. For this, I see the physician having a necessity to be EM trained.

 

[bulgethetwine]

Why would they exempt them from working in a level I trauma center? One would think a level I trauma center would have available nearly every specialty as a consult service. In fact, the majority of level I trauma centers are teaching institutions with in-house consultant services.

I would argue that FP's could work in level I or academic centers that do not have an EM residency, but NOT in rural areas. In rural areas, there is no consult service readily available and EM physicians must manage any and everything that comes through the door. For this, I see the physician having a necessity to be EM trained.

Fair point. I suspect it is driven more by supply and demand (the rural centres will take what they can get) rather than trying to objectively assess which skill sets and support services would be more compatible with EPs vs. FP+1s (as they are referred to).

Even with support services, though, there is still the initial trauma management that I suppose they want someone with more robust experience at leading a trauma team. But that is, afterall, what the extra year is supposed to be for... plus we all know that traumas are run well when they are run just like the cookbook says.

 

[Apollyon]

An Interesting compromise has arisen in Canada -- a hybrid pathway available to family practice residency graduates. They take an extra year of residency training in emergency medicine, kind of like an EM fellowship but without the academic focus. Instead, they focus on the nuts and bolts of working the ED, probably not unlike months 18-30 of a typical PGY 1,2,3 residency. AFter that, they apply for a special designation -- not equivalent to a fully trained EP, but a special designation nonetheless.

They are then permitted to work in emergency departments EXCEPT Level I trauma centres (i.e. underserviced areas). It is an interesting approach brought about in part because it is harder to train sufficient EPs in a country where there are fewer urban centres. It has also resulted in a higher proportion of graduates choosing FP as a primary resiency because they don't feel as if there is a path of no return if they don't like/aren't adequately stimulated by FP (there are similar one year 'extra' years available in OBGYN, Anesthesia, and Sports medicine).

Even more interesting is the study done by the Canadian Medical Association exhibiting that 3 years out of the program, there was no significant difference in performance, malpractice, etc. between those who were fully EM certified vs. the FP + 1 configuration.

The hospitals are happy because they have enough (well, closer then they would be otherwise) docs in their ED.
The EM trained EPs are happy because their Level I job opportunities are protected.
The FPs are happy because they feel they got the best of both worlds: A general practice background with some extra training to cover the 20% of the cases (to borrow the stat from the above posts) they wouldn't likely see in an FP residency.

I am sure its not perfect, but it seems to be a better-than-average solution as far as stop-gap solutions go.

Of course, full disclosure would dictate that I add I am Canadian and still chose to do my residency south of the border in EM! 😀

However, at the same time, aren't there 2 tracks in Canada for EM boarding, with one being the Canadian College of Family Practice - which leads to the "CCFP(EM)" designation? Is that the same thing of which you speak? I thought CCFP-EM was a 3+2 configuration.

 

[bulgethetwine]

However, at the same time, aren't there 2 tracks in Canada for EM boarding, with one being the Canadian College of Family Practice - which leads to the "CCFP(EM)" designation? Is that the same thing of which you speak? I thought CCFP-EM was a 3+2 configuration.

You are correct in the first instance -- CCFP(EM) is the designation conferred to those who do family practice first. But it is actually 3 years in TOTAL -- Family practice is a 2 year residency in Canada plus the extra designation is only 1 more year for a TOTAL of 3.

That is one of the peculiar nuances of the Canadian system -- while most specialties are the same length in both countries (for example, gen surg =5, Internal =3, ) some specialties, of which FP and EM are examples, are different lengths. The ramifications are that if you want to go from the US to Canada in FP, no problem -- Canada thinks you've done an FP residency and then some by doing 3 years in the U.S. If you want to go from the US to Canada to do EM after completing a full residency in the U.S., BIG PROBLEM because a full EM residency in Canada is 5 years (including a mandatory 1 year of research regardless of your academic aspirations or previous work, e.g. Ph.D) and Canada says you have to make up the shortfall somehow.

Plus, you have to take ice skating lessons. 😀

 

[eadysx]

I don’t mean to hijack here, but my question is a little off topic. If an ED is staffed with FP docs rather than EM docs, does the hospital have to pay more for med. mal. Insurance? If not, what is the incentive for a hospital to seek out EM docs, other than an obvious more focused training with better projected pt outcomes? Is there a penalty for not having EM trained docs around? I am not trying to stir anyone up here; I am just a dumb med student who really doesn’t know.

Thanks,

E-

 

[deleted6669]

I don’t mean to hijack here, but my question is a little off topic. If an ED is staffed with FP docs rather than EM docs, does the hospital have to pay more for med. mal. Insurance? If not, what is the incentive for a hospital to seek out EM docs, other than an obvious more focused training with better projected pt outcomes? Is there a penalty for not having EM trained docs around? I am not trying to stir anyone up here; I am just a dumb med student who really doesn’t know.

Thanks,

E-

board certified em docs won't work for 75 dollars/hr. fp docs will.

 

[southerndoc]

board certified em docs won't work for 75 dollars/hr. fp docs will.

I get paid that for internal moonlighting as an intern!

 

[stoic]

board certified em docs won't work for 75 dollars/hr. fp docs will.

just fyi, the fp's doing EM work that I've shadowed make about twice that.

 

[deleted6669]

I guess it varies. I work with a group that covers several facilities. one is a busy trauma ctr with only bc em docs making 145 dollars/hr and another is a smaller facility with fp docs making 70-80/hr. when the em docs work at the small facility they still make 145/hr.also in the past when we have used moonlighters they always pay the em residents more than the fp residents. the em residents make 100/hr while the fp residents make 50-60/hr.

 

[Apollyon]

And here I am, thinking I'm King **** by making $15/hr working on the bus as a paramedic when I was in med school (to clarify, I am EMT-P also, in addition to MD). As a caveat, that was 3 years ago, and I am SURE that that paramedics are making MUCH, MUCH more now.