Interested in multiple fellowship fields

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MoGhazidoc1990

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Hello,

I am a final year med student. Have a great interest in Emergency medicine. I am just wondering that, if hopefully I get an EM residency and complete it, if I wanted to pursue to different fellowships one after the other if its possible.

I wanted to do a trauma and critical care fellowship, but also I am really interested in wilderness medicine and prehospital care.

Is there any restriction on whether or not you can do multiple fellowships?
If possible is it discouraged?
Does Wilderness medicine have a trauma component built into it?
I want to join the military after wards. Will they accept a civilian wilderness program?

Thanks

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Critical care is 2 years and trains you to work in the icu. This is almost the exact opposite work environment of ems/prehospital... you have to ask yourself if you want to work in the icu or not.


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Hello,

I am a final year med student. Have a great interest in Emergency medicine. I am just wondering that, if hopefully I get an EM residency and complete it, if I wanted to pursue to different fellowships one after the other if its possible.

I wanted to do a trauma and critical care fellowship, but also I am really interested in wilderness medicine and prehospital care.

Is there any restriction on whether or not you can do multiple fellowships?
If possible is it discouraged?
Does Wilderness medicine have a trauma component built into it?
I want to join the military after wards. Will they accept a civilian wilderness program?

Thanks
There is no "trauma" fellowship after EM - only for general surgery. You actually named 3 legitimate fellowships - critical care, wilderness medicine, and EMS (prehospital). Critical care trains you to work in an ICU. Most EM docs that complete this work let time in an ICU and part time in the ED. EMS trains you to become a medical director for an EMS organization, whether that's a city, county, zone within a city, etc. Don't be fooled into thinking that an EMS fellowship is somehow turning you into a mobile EM doc in the field/streets. It's more of a logistical fellowship - creating the SMP's for the paramedics, reviewing quality control for the dispatch, providing medical contril decisions when needed over a radio. Wilderness medicine - well, it's cool but I'm not totally sure what they do for a full year.
 
Wilderness medicine - well, it's cool but I'm not totally sure what they do for a full year.

Get drunk in the woods, get drunk at conferences, moonlight at OSH and teach the med students about frostbite
 
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Hello,

I am a final year med student. Have a great interest in Emergency medicine. I am just wondering that, if hopefully I get an EM residency and complete it, if I wanted to pursue to different fellowships one after the other if its possible.

I wanted to do a trauma and critical care fellowship, but also I am really interested in wilderness medicine and prehospital care.

Is there any restriction on whether or not you can do multiple fellowships?
If possible is it discouraged?
Does Wilderness medicine have a trauma component built into it?
I want to join the military after wards. Will they accept a civilian wilderness program?

Thanks

Just focus on picking the program you like best and worry about fellowship later, you will experience a lot as a resident and meet a lot of people who have been through these fellowships, and this will likely affect your decision. I was more than a little interested in fellowships this time last year but as I head towards the tail end of first year as a resident I am realizing that more than anything I just want to be finished with being a student.

Not saying this will happen to you, but I think you need to ask yourself why you would want to do multiple fellowships. Realistically it is hard enough for a fellowship trained ED doc to get a true CC position utilizing all of their skills, you are highly unlikely to find or create a position in which you would be able to put the training from multiple fellowships to good use. Moreover, there is only so much room in the brain and time in the day, you are going to have a hard time keeping up to date on the latest in EM, CC, and EMS/Wildnerness. Especially if you aspire to have a significant other, kids, friends, personal time, etc.

Finally make sure you have a plan for what you will do with any fellowship. As one of my directors said, "fellowships are great but if you are going to do one know why you are doing it. Wanting to run an ICU and pickup occasional shifts in the ED is a great reason to do a CC fellowship. Doing a CC fellowship because you love Weingart and want to do cool **** at Shock Trauma for a couple years is not". You could be an EM attending at hundreds of shops around the country and do ED trauma/CC to your hearts content without wasting two years and hundreds of thousands of dollars.

Wildnerness medicine is just unnecessary IMO, if you like the outdoors you can tailor your practice to that without a year, and hundreds of thousands, wasted on a fellowship. I have talked to a few people who have done or are doing WM fellowships and never really got a straight answer as to what the benefit was. The most honest doc told me that he loved getting out into the woods and this was a way to justify doing so to his wife.
 
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Critical care is 2 years and trains you to work in the icu. This is almost the exact opposite work environment of ems/prehospital... you have to ask yourself if you want to work in the icu or not.


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Great can you possibly give some insight on this particular em/cc fellowship I found based around trauma at the Shock trauma center in Baltimore. Here is the link
http://umm.edu/programs/shock-traum...s/emergency-medicine-critical-care-fellowship
It's based on trauma I think
 
Great can you possibly give some insight on this particular em/cc fellowship I found based around trauma at the Shock trauma center in Baltimore. Here is the link
http://umm.edu/programs/shock-traum...s/emergency-medicine-critical-care-fellowship
It's based on trauma I think

Emergency physicians can do critical care fellowships through multiple pathways. Many are through the internal medicine side of things. Some are through surgery, some through anesthesia.

IM-CC largely prepares you to work in a MICU
Surg-CC prepares you to work in a surgical ICU.
Anesthesia-CC prepares you to work in a surgical ICU

There is cross training for all of them and some do work in the opposing units (or at community hospitals where you do everything).

Although programs like the one you showed have you rotate on a trauma service/Trauma-ICU, you are not becoming a trauma surgeon. You'll never be running a trauma service. That's for surgeons, which we are (thankfully) not.
 
This guy went round and round on the Military Med forum asking, repetitively, how he could be a doctor AND a special forces operator. Not to hammer on the guy, but he seems to have a trauma fixation, but not surgeon fixation.
 
Great can you possibly give some insight on this particular em/cc fellowship I found based around trauma at the Shock trauma center in Baltimore. Here is the link
http://umm.edu/programs/shock-traum...s/emergency-medicine-critical-care-fellowship
It's based on trauma I think
The ccm fellowship from IM is 1 year. The em ccm pathway requires a two year fellowship. Through the university of maryland you can apply to the surgical critical care route (which is the link you posted), or the im/ccm route. most surg/ccm programs that accept em grads require the fellow to complete essentially a surgery intern year fof their first year. The second year is the actual fellowship where you spend most all time in the trauma icu.

This pathway sounds like a raw deal to me, unless youre a glutton for pain...

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Looking through your post history, it seems that your end goal will be best achieved by just doing a residency at a location with a high volume of trauma.

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The ccm fellowship from IM is 1 year. The em ccm pathway requires a two year fellowship.

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That's not really true. CCM is a 2 year fellowship off IM. There is a caveat that is can (but doesn't have to be) a one year fellowship if you have already done another fellowship in internal medicine. So you cannot just do an IM residency, one year of CCM then take the boards. You can do IM then any medicine subspecialty (there may be a caveat that it has to be a 2 year fellowship - don't entirely remember) then one year of CCM and take the boards.

So we can do the exact same thing that medicine does.
 
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The ccm fellowship from IM is 1 year. The em ccm pathway requires a two year fellowship. Through the university of maryland you can apply to the surgical critical care route (which is the link you posted), or the im/ccm route. most surg/ccm programs that accept em grads require the fellow to complete essentially a surgery intern year fof their first year. The second year is the actual fellowship where you spend most all time in the trauma icu.

This pathway sounds like a raw deal to me, unless youre a glutton for pain...

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I misspoke! My main point is that of the three pathways, surgery seems like more of a pain lol

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This guy went round and round on the Military Med forum asking, repetitively, how he could be a doctor AND a special forces operator. Not to hammer on the guy, but he seems to have a trauma fixation, but not surgeon fixation.
Your right I did however after reading what people said about this in those posts I have really seen that that is not even a route I can use and that doctors have a specific role to play and that is not a actual door kicker.
However maybe a Battalion surgeon or an operational unit surgeon providing trauma care in a role II facility is something I want to achieve.
Again, not trying to become a door kicker now but to play the role I need to to be effective
 
Sign me up!
Problem is that the boards for wilderness medicine are tough. They inflict an open tib/fib fx on you after making you drink giardia and then drop you off in the middle of the Cascades. If you make it back to civilization - board-certified!
 
Problem is that the boards for wilderness medicine are tough. They inflict an open tib/fib fx on you after making you drink giardia and then drop you off in the middle of the Cascades. If you make it back to civilization - board-certified!
I got the fever - beaver fever!
 
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Your right I did however after reading what people said about this in those posts I have really seen that that is not even a route I can use and that doctors have a specific role to play and that is not a actual door kicker.
However maybe a Battalion surgeon or an operational unit surgeon providing trauma care in a role II facility is something I want to achieve.
Again, not trying to become a door kicker now but to play the role I need to to be effective


Again, I think people are saying that it looks like you want to be a trauma surgeon. Which is great, if you're a surgeon. An EM doc, even with a SCC fellowship, is not a surgeon. I'm not entirely sure how the military works, but I can't imagine they'd let a non-surgeon operate as a surgeon (someone can correct me on that if I'm wrong). I know I'd rather have any non-fellowship trained general surgeon open me up than an EM doc with an ICU-heavy fellowship. Have you considered general surgery with a fellowship after?
 
Again, I think people are saying that it looks like you want to be a trauma surgeon. Which is great, if you're a surgeon. An EM doc, even with a SCC fellowship, is not a surgeon. I'm not entirely sure how the military works, but I can't imagine they'd let a non-surgeon operate as a surgeon (someone can correct me on that if I'm wrong). I know I'd rather have any non-fellowship trained general surgeon open me up than an EM doc with an ICU-heavy fellowship. Have you considered general surgery with a fellowship after?
In the military, "surgeon" is an antiquated term when used in the context of "Battalion Surgeon." It's all primary care. No surgery unless you're cutting off a mole lol.

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Your right I did however after reading what people said about this in those posts I have really seen that that is not even a route I can use and that doctors have a specific role to play and that is not a actual door kicker.
However maybe a Battalion surgeon or an operational unit surgeon providing trauma care in a role II facility is something I want to achieve.
Again, not trying to become a door kicker now but to play the role I need to to be effective
I think you still have a poor understanding of military medicine, despite all the advice those in the milmed forum have provided you. Back during the surge, things were crazy for em docs and surgeons. Not so much now. Plan on being bored in the military. If something cool happens, then great. But swoopty things are the exception, not the rule.

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regardless of what fellowship you do, we don't have keys to the OR. at least not in US style medicine. if you do peace corps, doc without borders, religious organizations, rural overseas medicine where it doesn't really matter. yeah, you'll be assisting/doing stuff way outside the EM scope. but then no one from a village is going to sue you. maybe take your head off with a club for not saving their kid but that's the price to pay for primitive medicine. I've done 3 fellowships and I am retired military. the military is not going to care about the wilderness med. the only thing they care about is your MOS (military occupational specialty). I have friends that are a plastic surgeon that was tossed into a trauma surgeon role. his CV said he completed a general surgery residency prior to plastics so *poof* you're now a trauma surgeon. others who didn't even do an internship yet, got sent overseas as a general medical officer (family practice stuff). here's a handbook on basic medicine. good luck. the military tries to send the GMO to low acuity bases/smaller ships but things do happen there too. there's always higher up/command level you can call for help but there may/may not be anyone present to see the pt with you. transferring out could be hours to days depending on transport

you can do as many fellowships as you want. no one is going to discourage you. there's no limit. only on how much you want to:
1. put time in with full legal responsibilities and 1/4- 1/2 of the pay
2. have your loans pile up or live like a resident again while paying your loans off. once you graduate residency they want their money back
3. have some protected time to do whatever it is you're interested in
4. have a title to help with networking opportunities
5. take on administrative functions for free/learn (fellows help unload attending admin/non clinical crap)
6. if you're obligated to the military, it doesn't matter. they'll stop you from entering fellowship if they need you to deploy after graduation

think about what you want to do in 7 yrs. is it part ICU/ED. ems director? med director? there's a new EM/anesthesia program I wish they had when i was in. most colorful "fellowships" help pad the ED operating budget w cheap labor b/c you're there all year and never leave the dept. do you really need to do a wilderness med fellowship? or do you want to do it on line, on your own time, having drinks at conferences while making full attending pay? some fellowships like u/s, ICU, peds, tox...etc you gotta do b/c you need the resources there. stuff like wilderness, international, admin/mba you can do on the side.

if you want to know the military exp from a EMS turned GMO, now EM resident PM me, I'll pass along your email
 
Great can you possibly give some insight on this particular em/cc fellowship I found based around trauma at the Shock trauma center in Baltimore. Here is the link
http://umm.edu/programs/shock-traum...s/emergency-medicine-critical-care-fellowship
It's based on trauma I think


Awesome fellowship but its going to take you years to find the job where you can use both and EM residency and SCC fellowship. This is a small field so the opportunities are limited if you want to really put both aspects to good use.
 
Your right I did however after reading what people said about this in those posts I have really seen that that is not even a route I can use and that doctors have a specific role to play and that is not a actual door kicker.
However maybe a Battalion surgeon or an operational unit surgeon providing trauma care in a role II facility is something I want to achieve.
Again, not trying to become a door kicker now but to play the role I need to to be effective


Dude be a combat medic if you want the military angle. You don't need 10-15 years of higher education to be involved in military medicine. It will take more than that to be a fellowship trained EM doc.
 
Awesome fellowship but its going to take you years to find the job where you can use both and EM residency and SCC fellowship...

Nonsense.
How many EM/CCM grads do you know?
I know plenty and NONE has had trouble finding a job. I could find three tomorrow that would "use both and [sic] EM residency and SCC fellowship...".
HH
 
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Nonsense.
How many EM/CCM grads do you know?
I know plenty and NONE has had trouble finding a job. I could find three tomorrow that would "use both and [sic] EM residency and SCC fellowship...".
HH
From what I've heard from home program fellows, this is generally true. I did see this recently from ACEP, suggesting nationally there could be some issues, specifically in the private practice realm.
 
Hello,

I am a final year med student. Have a great interest in Emergency medicine. I am just wondering that, if hopefully I get an EM residency and complete it, if I wanted to pursue to different fellowships one after the other if its possible.

I wanted to do a trauma and critical care fellowship, but also I am really interested in wilderness medicine and prehospital care.

Is there any restriction on whether or not you can do multiple fellowships?
If possible is it discouraged?
Does Wilderness medicine have a trauma component built into it?
I want to join the military after wards. Will they accept a civilian wilderness program?

Thanks

Realize that you will have some exposure to all this stuff in residency and you probably won't be interested in doing a fellowship in all of them by the time you're done with residency.

You could do all the fellowships you want, but I suspect your interest in them will wane a bit and you may still do one.

And financial reality may hit, depending on your loan burden, you may not be able to afford to do one fellowship, much less multiple. At some point you've got to get the return on all the years you've invested. You've got student loans to pay back, a house to pay for, a retirement to fund and maybe a spouse to keep happy and some kids whose college needs paid for. You can't play med student your whole life.
 
Nonsense.
How many EM/CCM grads do you know?
I know plenty and NONE has had trouble finding a job. I could find three tomorrow that would "use both and [sic] EM residency and SCC fellowship...".
HH

I agreed. I get plenty of recruiting emails regularly.
 
Nonsense.
How many EM/CCM grads do you know?
I know plenty and NONE has had trouble finding a job. I could find three tomorrow that would "use both and [sic] EM residency and SCC fellowship...".
HH

Yes you're going to find job no problem, but so is any board certified EM doc. I'm referring to finding a where you are actually being paid significantly more for those extra years of training. From what I've seen its not easy, despite a-list credentials/experience in both EM and CC fellowship.
 
Awesome fellowship but its going to take you years to find the job where you can use both and EM residency and SCC fellowship. This is a small field so the opportunities are limited if you want to really put both aspects to good use.

Yes you're going to find job no problem, but so is any board certified EM doc. I'm referring to finding a where you are actually being paid significantly more for those extra years of training. From what I've seen its not easy, despite a-list credentials/experience in both EM and CC fellowship.

You seemed to have moved the goalposts quite far. I am amazed that you would make two such conflicting statements within the same discussion and same thread.

And even with this new topic (new goalpost settings), I suspect you are incorrect. Anecdotal evidence and reason (comparing CCM income to EM income [admittedly structured differently]) is all I have, but these support the claim that EM/CCM jobs -- at the very 'least' -- offer equivalent salaries to EM-only jobs (most likely considerably higher). And this is in the setting of your last admission that finding such an EM/CCM job is "no problem".

Care to move the goalposts again?
Care to provide a basis or experience for your repeated assertions, contradictory as they are?

HH
 
You seemed to have moved the goalposts quite far. I am amazed that you would make two such conflicting statements within the same discussion and same thread.

And even with this new topic (new goalpost settings), I suspect you are incorrect. Anecdotal evidence and reason (comparing CCM income to EM income [admittedly structured differently]) is all I have, but these support the claim that EM/CCM jobs -- at the very 'least' -- offer equivalent salaries to EM-only jobs (most likely considerably higher). And this is in the setting of your last admission that finding such an EM/CCM job is "no problem".

Care to move the goalposts again?
Care to provide a basis or experience for your repeated assertions, contradictory as they are?

HH

How were my assertions contradictory? Let stop the personal attacks hammy. I was referring to the fact that you can find a job in EM doing EDCC no problem but plenty of non fellowship docs work EDCC too. From what I've seen running an ICU or having a high level position as an ED doc is much harder, and will take years to attain even with great credentials. You're not going to be out of a job but you won't be scott weingart after finishing your CC fellowship either.
 
How were my assertions contradictory? Let stop the personal attacks hammy. I was referring to the fact that you can find a job in EM doing EDCC no problem but plenty of non fellowship docs work EDCC too. From what I've seen running an ICU or having a high level position as an ED doc is much harder, and will take years to attain even with great credentials. You're not going to be out of a job but you won't be scott weingart after finishing your CC fellowship either.

I really don't understand what you're saying. I'm EM/CCM in fellowship currently. I get recruiting emails constantly. CCM jobs aren't hard to come by for EM docs.
 
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