jumped ship

[sin]

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My wife became pregnant last fall (a few months into her 2nd year of OB/Gyn residency). Though she wanted to quit mid-year, her chairman and program director brainwashed her into finishing out the year (they basically threatened legal action for breach of contract, as well as hinting that she would be blacklisted...but that's another story). Anyway, despite the 110+ hr work weeks and Q2 call (up to a week before she delivered!), our baby daughter turned out healthy. My wife went back to work a few weeks after delivery, and finished out the year, and finally quit the program (Thank the Lord!!!!). She wants to take a couple years off to take care of the baby, and plans to go back to residency. Fortunately, she has come to her senses and is going to try to find a position in emergency medicine, instead of OB/gyn. So she will be basically starting all over. Before applying, she is planning on taking her Step III this fall, in order to get her license so that she can work/moonlight in an ER, to get some experience before applying. My question is

1) Is there anyone out there who has moonlighted/worked in an ER, though not in a residency program (Is it still called moonlighting if you're not currently in a residency program?)

2) Any suggestions on how to approach trying to get a position in emergency medicine, given her background

3) What's the likelihood of getting a position outside the match so that she doesn't have to go thru ERAS again

4) If she does have to go thru the match again, can she use her old letters of rec?

5)Anyone else out there in the same situation (or knows someone in a similar situation?)

Though things are somewhat hectic right now, I am really happy that my wife was able to escape that godforsaken field, and that our baby turned out healthy. I truly believe everything happens for a reason. By the way, did I mention that OB/gyn sucks!

 

[buggymd]

I am currently a first year ob/gyn resident, and am seriously thinking about jumping ship. I know that for ER, open residency positions are listed at a central site, I think it's www.saem.org.

Although I have no personal experience I think that it would be more difficult to get a position after being out for a while, she might have better luck trying for a spot next year. That's just my two cents worth, good luck!

 

[Sessamoid]

D@mn it, i posted a long reply to this but the bbs evaporated it. I'll post again when I'm back from work, I guess.

 

[Square Pants]

I am also very interested to know if it is possible to moonlight in the ER when you are not a resident. I am planning to do a PGY1 year only and then jump into the less insane world of research. I hope to be able to moon-light while doing research (and NOT in any residency). Any thoughts???
Thanks

 

[Sessamoid]

Originally posted by sin


1) Is there anyone out there who has moonlighted/worked in an ER, though not in a residency program (Is it still called moonlighting if you're not currently in a residency program?)

I have a lot of ethical problems with this personally. Does your wife's desire to moonlight in an ER pass the "yo mama" test? In other words, if your mother were to suddenly fall very ill and required intensive care in an emergency department, would you feel comfortable with a physician with her level of training taking care of her sepsis/MI/appendicitis/etc.? This answer is especially for the person who posted just previously to my message. I personally wouldn't want any friend or family member of mine being cared for by somebody with only two years of Ob/Gyn residency or a single year of general internship. And imagine how you/your wife would feel if, through inexperience and lack of training, a patient were to die in her care that wouldn't have in the care of an experienced physician? The money may be tempting, but I think it is morally wrong unless the region you happen to live in is so strapped for physicians of any kind, that even an unqualified physician is better than none at all.

The financial aspect is that trying to get anybody to insure you for that kind of practice will be next to impossible.

2) Any suggestions on how to approach trying to get a position in emergency medicine, given her background

She really needs to talk to somebody who would know this, preferably a residency program director in emergency medicine. Even if they don't take physicians with previous training, a program director is pretty likely to know other programs that do.

3) What's the likelihood of getting a position outside the match so that she doesn't have to go thru ERAS again

Slim to none. EM is pretty competitive and the slots fill quickly. Unless she's very close friends with a residency director or department chair, that'll be closer to "none" than "slim".

4) If she does have to go thru the match again, can she use her old letters of rec?

Yes, though they won't be that relevant. What will be important is that she get good referrals from her Ob/Gyn faculty. Her performance as a medical student is going to pale in importance to her performance as a resident.

 

[Square Pants]

Originally posted by Sessamoid
This answer is especially for the person who posted just previously to my message. I personally wouldn't want any friend or family member of mine being cared for by somebody with only two years of Ob/Gyn residency or a single year of general internship.


UM, isn't that EXACTLY what you do as an intern? Hell, I've taken care of YO MAMA as a 4th year med student. Dude, we are not independent cowboys ordering whatever the hell we want and doing whatever procedure we want. There are rules and regulations to protect the patient. There is a chain of command, even for EM residents.

And, btw, when would YOU have residents assume patient responsibility? At the end of residency? When they are a third year? It doesn't work that way. Like it or not, the most lowly intern takes care of YO MAMA from the first day of residency.

Every intern that I have seen moon-light is under the direct supervision of the ER attending. In my hospital, moon-lighters are god-sends in that they allow the program to stay under the 80 hour limit.

In so far as malpractive insurance is concerned, I am sure you can get insurance through the hospital you moonlight for (a IM intern I've worked with was talking about exactly this aspect of his moonlighting salary - - - it ain't cheap).

You are the first person that I've heard whine and complain about this, but you offer no evidence against its practice, other than your own personal opinion. Moonlighters are here to stay. Might as well get used to it.

Let the Flame War begin....

 

[Sessamoid]

Perhaps I've misunderstood you then. You seem to be talking about moonlighting with the same program she's training in? You didn't make that at all clear in your original message. Instead, what I thought you were talking about was working independently in an emergency department without any supervision whatsoever. Re-read your post and see the vagueness.

In any case, the SAEM's (Society for Academic Emergency Medicine) official position on this matter is that interns shouldn't be moonlighting/working outside their regular duty hours AT ALL, and EM program directors generally follow those guidelines. I find it highly unlikely your wife will be allowed to work hours in addition to her residency hours. There are also regulations which forbid EM residents from moonlighting in the same practice environment in which they train.

Like I stated, it depends on your geographical location. I know that in my metropolitan area the chances of ANY ED hiring somebody with only 2 years Ob residency experience are ZERO. All the ER docs in the area are at least family or IM trained, and the vast majority are EM residency trained and board certified.

 

[Square Pants]

yes, I mean moon light when you are *not* a resident.
(i.e. leave residency after intern year, and then moonlight).

Independent malpractice insurance is offered to anyone with a medical license. Also, you do not work as an attending, you work as an intern in the ED.

 

[Square Pants]

I know some one who is doing exactly what I stated. He's in CA. Let me talk with him and find out what the specifics are, and then I'll post the info here. Gimme a few days...

 

[Sessamoid]

Originally posted by Square Pants
yes, I mean moon light when you are *not* a resident.
(i.e. leave residency after intern year, and then moonlight).

Depends on the desperation of the area you live in. Won't happen here. We won't hire them, period. Too much danger involved. We do have interns from family medicine and Ob residency programs rotate through our ED for a month at a time. I like them and all, but they do NOT help us see patients. In contrast, they are a huge drag on our productivity. Interns are worse than useless in a busy ER setting. Go read the thread we're having on how many patients residents are seeing per hour.

Independent malpractice insurance is offered to anyone with a medical license. Also, you do not work as an attending, you work as an intern in the ED.

Getting harder and harder to get malpractice in many parts of the country, and it's getting vastly more expensive, even if you're board certified in EM. Miami EM docs looking for new malpractice are being quoted figures around and above $100,000 per year. So possible, yes. Easy, no. Again it depends on where you are.

 

[DrQuinn]

I don't think any intern in whatever specialty should be moonlighting. As an EM intern, I *probably* might be able to get by working in a Fast Track... but with mistriaging and what-not, it is probably a risky situation.

While I did my EM electives, most of the 2nd years didn't moonlight... they said they didn't quite feel comfortable yet... but approaching the end of their second year they said they would probably start moonlighting (which I can see) at a low volume urgent care center (where if you see something a little more seirous you can turf over to the ED).

Some programs I interviewed at did have EM residents moonlighting at their home institution in the FAst Track. What a lucky option.

I hear so many of hte IM residents say "I could work in the ED, those guys don't know what the hell they're doing." They base their opinion on walking down to the ED maybe twice a day to see ONE patient who has already had half the workup completed and is waiting for dispo. THey dont' see the 40 names on the board, the one patient that is about to code in Major Medical, the trauma that just got brought in, the three vag bleeders (two are orthostatic), the two lacs that need repaired, the three possible acute abdomens that need re-evaled, and oh crap two people with ST elevation just walked in.

Even though most people moonlight at low volume, *hopefully* low acuity EDs, that doesn't mean the person that EMS is bringing in is low acuity.

I could *probably* get by at a rural ED in a year. I'd probably shotgun quite a few patients and CT just about everything. Such is what happens with inexperience.

I am not sure that people with an IM or FP background (much less OBGYN) see the patient volume/breadth of pathology that I would.

Moonlighting is NOT always the answer. For my mama anyways. I'll drive mi madre to St. Pete to be seen by an FACEP or ABEM certified colleague anyday.

Q, DO

 

[sin]

Originally posted by Sessamoid
Perhaps I've misunderstood you then. You seem to be talking about moonlighting with the same program she's training in? ...

Let me try to clarify a few things...My wife is not currently in residency, and wishes to work in an ER in order to get some experience prior to applying for an ER residency position, not so much to make extra money. In medical school, I know that there were many 3rd and 4th year students who "externed" at a semi-rural ER under the supervision of an ER attending. That's the type of work that my wife is looking for. If this doesn't seem realistic due to liability/malpractice insurance, are there any other types of things (i.e. research, etc.) that my wife can do to help her get into an ER residency. I guess my question is what are some things that she could be doing now, in order to make her a stronger candidate when she applies for EM in about a year from now. I really appreciate any and all input.

 

[DrQuinn]

I don't really think your wife needs to "buff up" her application. EM isn't *necessarily* about the numbers or research... Scrubbs, in another post, I think in the EM forum, says in his opinion, EM is more about hard work and getting along with colleagues than it is the numbers. I agree.

Some programs may look favorably on her for having extra training. I know in my program, we have one intern who is a Peds/IM attending, one flight surgeon from the military, and one other person with a transitional year under his belt.

As long as your wife didn't screw the pooch on the USMLE... she should be okay. Get some strong LORs from some ED attendings (one from a residency would be ideal) and just apply.

Q, DO

 

[Sessamoid]

I'm with Quinn. There are certain residencies that are more keen on taking docs with prior training. The program I graduated from (Texas Tech in El Paso) traditionally was more open to docs with previous training. We generally took one applicant with previous training per year, occasionally more. Moonlighting in an ED wouldn't necessarily be an advantage on the application.

In my class, we had an IM boarded doc. The class after mine had a Peds-boarded doc, a former FP faculty at a teaching program, and another with a transitional year behind her. The FP guy had worked in the ED for years, but the pediatrician had never worked in an adult ER before, nor did he moonlight in one. Having those guys was a great boon to those of us who came straight out of school because we essentially had another faculty-level opinion available to us early in our training. The pediatrician was especially helpful in some cases where even our EM attendings were stumped.