Just finished my em fellowship!

[Perrotfish]

If anyone has questions please feel free to ask.

What was the structure of the fellowship? Did you do any rotations outside of the ED? Any research months? How many shifts/month?

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[DO2015CA]

Its interesting to see the contrast between how the FM Emergency medicine fellowship is perceived vs the Pediatrics emergency medicine fellowship. Right or wrong Peds EM docs have convinced the majority of children's hospitals that their fellowship trained pediatricians are the best option and that someone with just an EM residency is a 2nd best option. On the other hand it seems like even FPs buy into the idea that their fellowship is a second best option behind an EM residency.

But it’s true though. Peds aren’t just small adults. Kids have different standards and protocols. You’d be surprised how many kids show up to the children’s hospital mismanaged by BC EM physicians. There is a reason PEM is a fellowship not only for peds but for EM as well. A lot of EM programs are great that have a lot of months in the P ER. But others don’t do nearly as much with kids

 

[Perrotfish]

But it’s true though. Peds aren’t just small adults. Kids have different standards and protocols. You’d be surprised how many kids show up to the children’s hospital mismanaged by BC EM physicians. There is a reason PEM is a fellowship not only for peds but for EM as well. A lot of EM programs are great that have a lot of months in the P ER. But others don’t do nearly as much with kids

Yes, I agree that it makes sense that Peds EM is a fellowship, particularly at pediatric tertiary care centers where every third child in the ED has a rare congenital disorder. What's interesting is that's its a pediatric fellowship, rather than just a fellowship off of emergency medicine. Peds EM has convinced most children's hospitals that a fellowship trained general pediatrician is actually better at managing pediatric emergencies than a residency trained EM doctor, and that they are equal to a fellowship trained EM doctor. On the other hand family medicine can't convince hospitals (or themselves) that a fellowship trained family medicine doctor is even equal to a residency trained EM doctor.

I wonder how much of that is about the actual competence of the graduates, and how much of that is just the relative success of the specialties in marketing themselves.

 

[DO2015CA]

Yes, I agree that it makes sense that Peds EM is a fellowship, particularly at pediatric tertiary care centers where every third child in the ED has a rare congenital disorder. What's interesting is that's its a pediatric fellowship, rather than just a fellowship off of emergency medicine. Peds EM has convinced most children's hospitals that a fellowship trained general pediatrician is actually better at managing pediatric emergencies than a residency trained EM doctor, and that they are equal to a fellowship trained EM doctor. On the other hand family medicine can't convince hospitals (or themselves) that a fellowship trained family medicine doctor is even equal to a residency trained EM doctor.

I wonder how much of that is about the actual competence of the graduates, and how much of that is just the relative success of the specialties in marketing themselves.

EM is a 3 year residency and PEM is a 3 year fellowship of just pediatric ER. PEM > EM. I believe PEM fellowship for EM should be 2 year fellowship rather than 3.

 

[Splenda88]

I wonder how much of that is about the actual competence of the graduates, and how much of that is just the relative success of the specialties in marketing themselves.

It's the latter... 80%+ of the things that come to the ED should/can be managed outpatient...

 

[DO2015CA]

It's the latter... 80%+ of the things that come to the ED should/can be managed outpatient...

Which would make the pediatrician the better go to

 

[KeikoTanaka]

Its interesting to see the contrast between how the FM Emergency medicine fellowship is perceived vs the Pediatrics emergency medicine fellowship. Right or wrong Peds EM docs have convinced the majority of children's hospitals that their fellowship trained pediatricians are the best option and that someone with just an EM residency is a 2nd best option. On the other hand it seems like even FPs buy into the idea that their fellowship is a second best option behind an EM residency.

Also, keep in mind Pediatric residencies ONLY focus on Pediatric populations. Meaning you have more time to focus on Emergent Peds needs. FM is so broad - you may not have the time to dive into the emergent intricacies of every single population (Peds/Geriatrics/Pregnant patients/female concerns, etc)

 

[Perrotfish]

EM is a 3 year residency and PEM is a 3 year fellowship of just pediatric ER. PEM > EM. I believe PEM fellowship for EM should be 2 year fellowship rather than 3.

They're not really 3 clinical years, though. They integrate at least a full year of research blocks, and usually a lot of elective time as well. Is there really that much clinical exposure than the FM fellowships?

 

[DO2015CA]

They're not really 3 clinical years, though. They integrate at least a full year of research blocks, and usually a lot of elective time as well. Is there really that much clinical exposure than the FM fellowships?

Looking at the closest PEM fellowship to me there is 4 research blocks for the entire 3 years. They also spend their electives rotating through PICU, anesthesia, ultrasound, child psych, etc. all extremely appropriate

 

[Perrotfish]

Also, keep in mind Pediatric residencies ONLY focus on Pediatric populations. Meaning you have more time to focus on Emergent Peds needs. FM is so broad - you may not have the time to dive into the emergent intricacies of every single population (Peds/Geriatrics/Pregnant patients/female concerns, etc)

At the same time Pediatric residencies have few emergencies in general, and Pediatricians in training are much more likely to be opposed by fellows than FM. If you do a pediatrics residency at a children's hospital with NICU and PICU fellows it is entirely possible to get through an entire pediatric residency without every placing a central line, managing an airway, or running a code. That a much longer way from being an emergency physician than your average FP.

 

[KeikoTanaka]

At the same time Pediatric residencies have few emergencies in general, and Pediatricians in training are much more likely to be opposed by fellows than FM. If you do a pediatrics residency at a children's hospital with NICU and PICU fellows it is entirely possible to get through an entire pediatric residency without every placing a central line, managing an airway, or running a code. That a much longer way from being an emergency physician than your average FP.

True, but, 3 year fellowship = basically another residency. Vs the 1 year FM EM fellowship.

 

[VA Hopeful Dr]

Its interesting to see the contrast between how the FM Emergency medicine fellowship is perceived vs the Pediatrics emergency medicine fellowship. Right or wrong Peds EM docs have convinced the majority of children's hospitals that their fellowship trained pediatricians are the best option and that someone with just an EM residency is a 2nd best option. On the other hand it seems like even FPs buy into the idea that their fellowship is a second best option behind an EM residency.

1 year v. 3 years

 

[Splenda88]

Which would make the pediatrician the better go to

Which would also make an FM residency with a 1-yr EM fellowship good to go as well. One can argue that FM/EM would do a better job curtailing the colossal waste of $$$ that happens in the ED.

Everyone got a cxr, trop, ekg, cbc, chem14, lactate regardless of chief complaint.

 

[DO2015CA]

Which would also make an FM residency with a 1-yr EM fellowship good to go as well. One can argue that FM/EM would do a better job curtailing the colossal waste of $$$ that happens in the ED.

Everyone got a cxr, trop, ekg, cbc, chem14, lactate regardless of chief complaint.

I agree. I think Fm/IM/peds is more than capable of handling all of the non-emergent ER issues. A local hospital where I used to live had usually 1-2 BC ER docs on that handled the trauma/intubation/chest tubes/etc. then had FM/IM doing cardiac workup level stuff. Then midlevels running the fast track. I felt this was a decent way to do it because they were paying 350-400k for 1-2 physicians and then other physicians would make substantially less and were well prepared for what they did

 

[Splenda88]

@DO2015CA

I meant an FM---EM (fellowship) will do a better job in handling the minor stuff w/o doing a million $ workup and also handle truly emergent cases...

 

[KeikoTanaka]

I agree. I think Fm/IM/peds is more than capable of handling all of the non-emergent ER issues. A local hospital where I used to live had usually 1-2 BC ER docs on that handled the trauma/intubation/chest tubes/etc. then had FM/IM doing cardiac workup level stuff. Then midlevels running the fast track. I felt this was a decent way to do it because they were paying 350-400k for 1-2 physicians and then other physicians would make substantially less and were well prepared for what they did

The hospital of the future - All Primary Care offices with direct access to the ED. They're in the midst of building this in Rochester, NY at Rochester General Hospital. Obviously the intent is to bring better healthcare to those who don't have insurance in an inner-city environment - while also preventing the rampant use of the ED.

 

[emergentmd]

EM here and debating who is best, what is the best route, whose stick is longer is no better than debating liberal vs conservative politics. People dig in, don't discuss with an open mind, are not humble to accept when they are wrong.

EM like every other field is governed by economics. No more, no less.

If 90% of radiologist or anesthesiologist died tomorrow, the hospitals will not shut down. Medicine will not cease to exist. Trust me, everything will go as normal and patients would have no idea anything changed.

EM docs would start working in the OR and unlit rooms esp if they pay 2x what we make now.

I am not delusional to think that if all EM docs died tomorrow, all of the hospitals would run reasonably well with FM/IM/APCs and every other specialty that ran ERs before EM was borm.

But for anyone to think that FM with EM fellowship is as good as an EM doc, they are poorly mistaken. Is there a subset of FM+EM fellowship that will do just as well as me? Sure.
But to think that 100 FM+EM would be equivalent to 100 EM boarded doctors, then there is no reason to discuss.

I am fine with FM+Em fellowship working at places where they can't attract EM docs or afford their pay. You take the next best thing. But they also better be aware that they can finish the EM fellowship and possibly have very limited EM jobs available as the EM field moves towards saturation.

 

[Splenda88]

@emergentmd

You sound more reasonable than the other poster (Lexdiamondz) who thinks even there is a 2-3 EM fellowship, it won't be good enough to practice EM. For that other poster, if it is not called 'EM residency', it's not good enough to practice EM.

 

[Kach]

What was the structure of the fellowship? Did you do any rotations outside of the ED? Any research months? How many shifts/month?

What was the structure of the fellowship?
12 months: 8 months one the trauma side, 4 months on the less acute side.

Did you do any rotations outside of the ED?
Yes. required rotations with 10 specialities including IR, surgery, ophtho, ob and 2 electives. Some were in the hospital, others in private offices.

Any research months? no

How many shifts/month? 16 12s

 

[Perrotfish]

But to think that 100 FM+EM would be equivalent to 100 EM boarded doctors, then there is no reason to discuss.

Why in the world wouldn't there be anything to discuss? An FM with a fellowship has more years of training than an EM doc. Most FM programs work more total hours during their residency than EM programs before they even get to fellowship. This is the model used to produce EM physicians in other first world countries.

I don't know if they are equivalent, but its certainly possible that the fellowship will produce equivalent physicians to the EM fellowship. Its possible that the FM fellowship produces superior EM physicians. There is certainly something to discuss here.

 

[Perrotfish]

1 year v. 3 years

I still think its more like 1 year vs 18 months. I maintain that most Peds EM fellowships are heavily geared towards future academics, with lots of research time and semi-relevant electives. It sounds like the FM fellowships are relevant clinical experience the entire way through.

 

[Sardonix]

EM here and debating who is best, what is the best route, whose stick is longer is no better than debating liberal vs conservative politics. People dig in, don't discuss with an open mind, are not humble to accept when they are wrong.

EM like every other field is governed by economics. No more, no less.

If 90% of radiologist or anesthesiologist died tomorrow, the hospitals will not shut down. Medicine will not cease to exist. Trust me, everything will go as normal and patients would have no idea anything changed.

EM docs would start working in the OR and unlit rooms esp if they pay 2x what we make now.

I am not delusional to think that if all EM docs died tomorrow, all of the hospitals would run reasonably well with FM/IM/APCs and every other specialty that ran ERs before EM was borm.

But for anyone to think that FM with EM fellowship is as good as an EM doc, they are poorly mistaken. Is there a subset of FM+EM fellowship that will do just as well as me? Sure.
But to think that 100 FM+EM would be equivalent to 100 EM boarded doctors, then there is no reason to discuss.

I am fine with FM+Em fellowship working at places where they can't attract EM docs or afford their pay. You take the next best thing. But they also better be aware that they can finish the EM fellowship and possibly have very limited EM jobs available as the EM field moves towards saturation.

Lol, I get what you are saying agree there is no replacing an EM residency. But you gotta appreciate the contradiction in tone here.

 

[Splenda88]

1 year v. 3 years

I guess you don't give them credit for rotating 2 months in ICU, 2-3 months ObGyn, 2-3 months ED during their FM residency...

This like saying FM will not be good at hospital medicine if they do 1-yr fellowship because they did not do an IM residency

 

[Splenda88]

Emergency Medicine		3
Pediatric Emergency Medicine		2
Orthopedics/ED Procedures		1
Emergency Medicine		1
Anesthesiology /Ultrasound		1
Internal Medicine		1
Medical ICU		1
Obstetrics/Gynecology		1
Otolaryngology/Ophthalmology		1

This is PGY1 schedule of the EM program where I am training in IM. Do people really get how many of these rotations that FM residents also do?



Below is PGY1-3 FM. Are people telling with 1-yr EM fellowship, one will not be equipped to work in the ED

PGY1

• Orientation
• Family Medicine Inpatient Service
• ICU
• Cardiology
• Newborn Nursery
• Pediatric Emergency Clinic
• Pediatric Wards
• OB
• Neurology
• Orthopedics
• General Surgery
• Family Medicine Center
• Behavioral Medicine

PGY2

• Family Medicine Inpatient Service
• Sports Medicine/Radiology
• ENT/Urology
• Opthamology
• OB
• Psychiatry
• Emergency Medicine
• Geriatrics
• Ambulatory Surgery
• Ambulatory Peds
• Palliative Care
• Elective

PGY3

• Family Medicine Inpatient Service
• Family Medicine Center
• Gynecology
• Dermatology
• Emergency Medicine
• Community Medicine
• Practice Management
• Electives (5)

 

[Lurts]

Emergency Medicine		3
Pediatric Emergency Medicine		2
Orthopedics/ED Procedures		1
Emergency Medicine		1
Anesthesiology /Ultrasound		1
Internal Medicine		1
Medical ICU		1
Obstetrics/Gynecology		1
Otolaryngology/Ophthalmology		1

This is PGY1 schedule of the EM program where I am training in IM. Do people really get how many of these rotations that FM residents also do?



Below is the PGY FM

• Orientation
• Family Medicine Inpatient Service
• ICU
• Cardiology
• Newborn Nursery
• Pediatric Emergency Clinic
• Pediatric Wards
• OB
• Neurology
• Orthopedics
• General Surgery
• Family Medicine Center
• Behavioral Medicine

I have done all the listed EM rotations in my current FM residency.

 

[Lurts]

I guess you don't give them credit for rotating 2 months in ICU, 2-3 months ObGyn, 2-3 months ED during their FM residency...

This like saying FM will not be good at hospital medicine if they do 1-yr fellowship because they did do an IM residency

This is the lot in life of the family doctor, though, unfortunately. Any more, not only does IM think we don’t belong as hospitalists (spare me the fellowship, I’ve been moonlighting as a hospitalist at a level 1 academic institution since PGY2 of family residency) but they also think they’re better outpatient PCPs than us these days lol.

 

[Splenda88]

This is the lot in life of the family doctor, though, unfortunately. Any more, not only does IM think we don’t belong as hospitalists (spare me the fellowship, I’ve been moonlighting as a hospitalist at a level 1 academic institution since PGY2 of family residency) but they also think they’re better outpatient PCPs than us these days lol.

Not going to lie... It's all about the $$$

 

[Lurts]

Not going to lie... It's all about the $$$

What’s all about the money? Falsely limiting the capabilities of your colleagues?

 

[Splenda88]

What’s all about the money? Falsely limiting the capabilities of your colleagues?

Yep...

 

[Perrotfish]

Most 3-year EM programs spend between 19-21 months in the ED (both peds and adult EM)

The argument for the FM fellowship pathway is that you can get the clinical experience you need for the ED outside the ED. You can learn how to manage rapidly decompensating patients on the floor and in the ICU. You can learn to diagnose and disposition initially vague patient complaints in the clinic. You can learn to manage a laboring patient on the labor deck.

If you are seeing the same pathology and doing the same procedures you have the same education, regardless of which room of the hospital you train in. Is there such a gap between what an FM and an EM sees in residency that it takes more than a 1 year fellowship to fix it?

 

[Splenda88]

The argument for the FM fellowship pathway is that you can get the clinical experience you need for the ED outside the ED. You can learn how to manage rapidly decompensating patients on the floor and in the ICU. You can learn to diagnose and disposition initially vague patient complaints in the clinic. You can learn to manage a laboring patient on the labor deck.

If you are seeing the same pathology and doing the same procedures you have the same education, regardless of which room of the hospital you train in. Is there such a gap between what an FM and an EM sees in residency that it takes more than a 1 year fellowship to fix it?

I actually agree with their argument to an extent but I do not think it takes more than one year to fix it (especially for FM docs)...

 

[emergentmd]

It really is not a matter of is doing XXX equivalent to being an EM doc or a Psychiatrist or a radiologist, or a surgeon, or 90% of the specialty

1. It is a matter of turf protection - Why would any EM doc or other specialty want to have their field encroached upon? All this would do is increase supply and drop pay. People can talk about diminishing the specialty or decreased care but all they really care about is $$$$. If you told EM docs (any specialty for that matter) that you will double our pay if we allow FM docs to work next to us then most would be all for it.

2. Liability. until this changes, most hospitals would not allow Non Boarded EM docs to work in the ER. They don't care about quality. All they care about is looking good that they have Boarded EM docs in the ER.

I am quite confident that I could train a 4th yr med student in 1 year to Be as good as the bottom 1/4 of EM.
I could train a PA/NP in 1 yr to be just as good as the bottom 1/4 of EM docs.

I am sure I could be a competent FM doc, IM doc, Rad, Gas, Hospitalist with a 6 month fellowship.

 

[VA Hopeful Dr]

I still think its more like 1 year vs 18 months. I maintain that most Peds EM fellowships are heavily geared towards future academics, with lots of research time and semi-relevant electives. It sounds like the FM fellowships are relevant clinical experience the entire way through.

So I looked up a few. 18 months of ED time seems pretty standard. But most also have things like PICU, trauma, tox, anesthesia in addition to that.

But even if we're being generous about research time, it's probably still an additional year of clinical training.

 

[VA Hopeful Dr]

I guess you don't give them credit for rotating 2 months in ICU, 2-3 months ObGyn, 2-3 months ED during their FM residency...

This like saying FM will not be good at hospital medicine if they do 1-yr fellowship because they did not do an IM residency

I guess you didn't read my earlier post in this thread:

Not helpful.

Would you rather someone like the OP or someone like me (just plain ole FP) working in the ED?

If we had enough board-certified EPs to cover every ED in the country, this wouldn't be an issue. We don't. This seems a decent 2nd best option.

But to answer your question: I think on average an IM grad is going to be better than we are at hospital medicine. The question becomes how much of a difference that extra inpatient training makes. I suspect not a huge difference most of the time.

Same thing with this discussion: on average I'd expect an EM residency trained doctor to be better than an FP even with the fellowship. Is that difference going to make a huge difference in outcomes? Probably not.

 

[Splenda88]

I am sure I could be a competent FM doc, IM doc, Rad, Gas, Hospitalist with a 6 month fellowship.

Not agreeing about the radiology part or even gas.

 

[MedicineZ0Z]

EM here and debating who is best, what is the best route, whose stick is longer is no better than debating liberal vs conservative politics. People dig in, don't discuss with an open mind, are not humble to accept when they are wrong.

EM like every other field is governed by economics. No more, no less.

If 90% of radiologist or anesthesiologist died tomorrow, the hospitals will not shut down. Medicine will not cease to exist. Trust me, everything will go as normal and patients would have no idea anything changed.

EM docs would start working in the OR and unlit rooms esp if they pay 2x what we make now.

I am not delusional to think that if all EM docs died tomorrow, all of the hospitals would run reasonably well with FM/IM/APCs and every other specialty that ran ERs before EM was borm.

But for anyone to think that FM with EM fellowship is as good as an EM doc, they are poorly mistaken. Is there a subset of FM+EM fellowship that will do just as well as me? Sure.
But to think that 100 FM+EM would be equivalent to 100 EM boarded doctors, then there is no reason to discuss.

I am fine with FM+Em fellowship working at places where they can't attract EM docs or afford their pay. You take the next best thing. But they also better be aware that they can finish the EM fellowship and possibly have very limited EM jobs available as the EM field moves towards saturation.

That's what ive been saying. On average, BCEM is absolutely ahead. 0 question. But the occasional FM will be just as good. Talent counts in every aspect of life.

 

[Kach]

Emergency Medicine		3
Pediatric Emergency Medicine		2
Orthopedics/ED Procedures		1
Emergency Medicine		1
Anesthesiology /Ultrasound		1
Internal Medicine		1
Medical ICU		1
Obstetrics/Gynecology		1
Otolaryngology/Ophthalmology		1

This is PGY1 schedule of the EM program where I am training in IM. Do people really get how many of these rotations that FM residents also do?



Below is PGY1-3 FM. Are people telling with 1-yr EM fellowship, one will not be equipped to work in the ED

PGY1

• Orientation
• Family Medicine Inpatient Service
• ICU
• Cardiology
• Newborn Nursery
• Pediatric Emergency Clinic
• Pediatric Wards
• OB
• Neurology
• Orthopedics
• General Surgery
• Family Medicine Center
• Behavioral Medicine

PGY2

• Family Medicine Inpatient Service
• Sports Medicine/Radiology
• ENT/Urology
• Opthamology
• OB
• Psychiatry
• Emergency Medicine
• Geriatrics
• Ambulatory Surgery
• Ambulatory Peds
• Palliative Care
• Elective

PGY3

• Family Medicine Inpatient Service
• Family Medicine Center
• Gynecology
• Dermatology
• Emergency Medicine
• Community Medicine
• Practice Management
• Electives (5)

And guess what i did with those electives (we had 4).... 2adult EM, 1 peds EM, 1 anesthesia

 

[emergentmd]

Not agreeing about the radiology part or even gas.

If I had a year of gas or radiology fellowship, I would just be about as good as an FM doing a EM fellowship.

Both would do great 95% of the time. Its the 5% that I would learn on the job and make mistakes.
No different than an FM+Em 1 yr fellowship. He would be fine 95% of the time. Its the 5% that he will make mistakes and learn on the job.

But isn't this similar to most residents who take on their first attending jobs? I ask for alot of advice when I just became an attending, read more, and not as efficient. Now, I rarely look much up other than a few med dosing at work.

Give me 1 yr in Gas or Rad intense fellowship and I am confident I would be as proficient as most new Grads.

 

[Kach]

Experience is the key. And it doesnt hurt to work with experienced EM docs. I went out of my way to take a second job in a bigger hospital just so I could work with other experienced docs. I recommend the same for other new grads. Residency and fellowship are important but I think an attitude of continuous learning and attainment of skills makes medicine more fun and makes us better providers.

 

[Kach]

Not agreeing about the radiology part or even gas.

canadians have a 1 year anesthesiology fellowship for FPs.

 

[Splenda88]

Experience is the key. And it doesnt hurt to work with experienced EM docs. I went out of my way to take a second job in a bigger hospital just so I could work with other experienced docs. I recommend the same for other new grads. Residency and fellowship are important but I think an attitude of continuous learning and attainment of skills makes medicine more fun and makes us better providers.

Can we take that word out of our vocabulary? We are physicians--not providers.

 

[Kach]

BTW does anyone know if the rosh review score estimator is accurate?

 

[Rekt]

Emergency Medicine		3
Pediatric Emergency Medicine		2
Orthopedics/ED Procedures		1
Emergency Medicine		1
Anesthesiology /Ultrasound		1
Internal Medicine		1
Medical ICU		1
Obstetrics/Gynecology		1
Otolaryngology/Ophthalmology		1

This is PGY1 schedule of the EM program where I am training in IM. Do people really get how many of these rotations that FM residents also do?



Below is PGY1-3 FM. Are people telling with 1-yr EM fellowship, one will not be equipped to work in the ED

PGY1

• Orientation
• Family Medicine Inpatient Service
• ICU
• Cardiology
• Newborn Nursery
• Pediatric Emergency Clinic
• Pediatric Wards
• OB
• Neurology
• Orthopedics
• General Surgery
• Family Medicine Center
• Behavioral Medicine

PGY2

• Family Medicine Inpatient Service
• Sports Medicine/Radiology
• ENT/Urology
• Opthamology
• OB
• Psychiatry
• Emergency Medicine
• Geriatrics
• Ambulatory Surgery
• Ambulatory Peds
• Palliative Care
• Elective

PGY3

• Family Medicine Inpatient Service
• Family Medicine Center
• Gynecology
• Dermatology
• Emergency Medicine
• Community Medicine
• Practice Management
• Electives (5)

Sounds like an absolutely trash EM program or a 4 year one.

I have 8 or 9 months EM PGY1 then 10 and 10. The rest is ICU.

I also did >15 interviews and all of them were very similar so you're essentially quoting an outlier. Almost all programs scrapped their floor months, ENT, Ortho, cards, etc.

It comes down to volume seen of the critically ill. You can pretend all you want, but you're not going to be seeing enough of it. You guys are honestly downright dangerous. Some of the workups and transfers I see from hospitals staffed by FMs is downright insane.

Splenda, you're probably more infatuated with EM than anyone on this forum, but you're absolutely clueless about it. Please stop spreading all your nonsense around.

 

[MedicineZ0Z]

Sounds like an absolutely trash EM program or a 4 year one.

I have 8 or 9 months EM PGY1 then 10 and 10. The rest is ICU.

I also did >15 interviews and all of them were very similar so you're essentially quoting an outlier. Almost all programs scrapped their floor months, ENT, Ortho, cards, etc.

It comes down to volume seen of the critically ill. You can pretend all you want, but you're not going to be seeing enough of it. You guys are honestly downright dangerous. Some of the workups and transfers I see from hospitals staffed by FMs is downright insane.

Splenda, you're probably more infatuated with EM than anyone on this forum, but you're absolutely clueless about it. Please stop spreading all your nonsense around.

Specify examples please.

 

[Splenda88]

Sounds like an absolutely trash EM program or a 4 year one.

I have 8 or 9 months EM PGY1 then 10 and 10. The rest is ICU.

I also did >15 interviews and all of them were very similar so you're essentially quoting an outlier. Almost all programs scrapped their floor months, ENT, Ortho, cards, etc.

It comes down to volume seen of the critically ill. You can pretend all you want, but you're not going to be seeing enough of it. You guys are honestly downright dangerous. Some of the workups and transfers I see from hospitals staffed by FMs is downright insane.

Splenda, you're probably more infatuated with EM than anyone on this forum, but you're absolutely clueless about it. Please stop spreading all your nonsense around.

No... It's a 3-yr program, and it's a top program in the south.

 

[Splenda88]

Splenda, you're probably more infatuated with EM than anyone on this forum, but you're absolutely clueless about it. Please stop spreading all your nonsense around.

Lol...

 

[Lexdiamondz]

The argument for the FM fellowship pathway is that you can get the clinical experience you need for the ED outside the ED. You can learn how to manage rapidly decompensating patients on the floor and in the ICU. You can learn to diagnose and disposition initially vague patient complaints in the clinic. You can learn to manage a laboring patient on the labor deck.

If you are seeing the same pathology and doing the same procedures you have the same education, regardless of which room of the hospital you train in. Is there such a gap between what an FM and an EM sees in residency that it takes more than a 1 year fellowship to fix it?

You would think so and yet somehow in my experience it doesn't seem to pan out that way.

My shop has IM and FM rotators in our Lvl 1 trauma centre. I precept these IM and FM PGY-2s and 3s and while they are smart and generally competent at their job they aren't very good at my job. In the last 4 shifts I've seen them

- mismanage an unstable AFib w a MAP in the 50s
- Fail an LP on a 22 year old with a BMI of 20.
- Completely overlook a tachypnoeic elderly pt in raging sepsis with ARDS because they forgot to take their sweater off and couldn't hear the crackles or see the intercostal retractions
- Miss an SBO because they thought the patient with an ex-lap scar was "drug seeking". Pt had a lactate of 5 and ischaemic changes on the CT

Nevermind the fact that whenever we work with FM and IM rotators my "precepting" usually means me seeing >70% of the patients on the team primarily and still dispo-ing them faster. Mind you, these are senior residents who in theory have spent considerable time in the ICU and have run codes and lead inpatient teams in their respective specialties.


An EM intern in October is usually better at emergency medicine and has than the vast majority of IM and FM senior residents. Their fund of knowledge is usually worse (understandably so) but their sense for sick v not sick and their overall efficiency is palpably better. To put it bluntly, I can count on one hand the number of IM residents and FM residents who I would trust to run a pod in the ED with minimal supervision - and even that would be a stretch.

Which would also make an FM residency with a 1-yr EM fellowship good to go as well. One can argue that FM/EM would do a better job curtailing the colossal waste of $$$ that happens in the ED.

Everyone got a cxr, trop, ekg, cbc, chem14, lactate regardless of chief complaint.

No you can't, especially when you consider the astronomically high percentage of patients we see who are sent from their PCP to "rule out XYZ" for complaints that aren't emergencies.


It's 2019 and we still have residency-trained IM and FM docs sending patients to the ER for asymptomatic HTN. Don't tell me these folks are somehow gonna save the ED money when they are a big reason why we are spending money on nonsense in the first place.

 

[MedicineZ0Z]

You would think so and yet somehow in my experience it doesn't seem to pan out that way.

My shop has IM and FM rotators in our Lvl 1 trauma centre. I precept these IM and FM PGY-2s and 3s and while they are smart and generally competent at their job they aren't very good at my job. In the last 4 shifts I've seen them

- mismanage an unstable AFib w a MAP in the 50s
- Fail an LP on a 22 year old with a BMI of 20.
- Completely overlook a tachypnoeic elderly pt in raging sepsis with ARDS because they forgot to take their sweater off and couldn't hear the crackles or see the intercostal retractions
- Miss an SBO because they thought the patient with an ex-lap scar was "drug seeking". Pt had a lactate of 5 and ischaemic changes on the CT

Nevermind the fact that whenever we work with FM and IM rotators my "precepting" usually means me seeing >70% of the patients on the team primarily and still dispo-ing them faster. Mind you, these are senior residents who in theory have spent considerable time in the ICU and have run codes and lead inpatient teams in their respective specialties.


An EM intern in October is usually better at emergency medicine and has than the vast majority of IM and FM senior residents. Their fund of knowledge is usually worse (understandably so) but their sense for sick v not sick and their overall efficiency is palpably better. To put it bluntly, I can count on one hand the number of IM residents and FM residents who I would trust to run a pod in the ED with minimal supervision - and even that would be a stretch.





No you can't, especially when you consider the astronomically high percentage of patients we see who are sent from their PCP to "rule out XYZ" for complaints that aren't emergencies.


It's 2019 and we still have residency-trained IM and FM docs sending patients to the ER for asymptomatic HTN. Don't tell me these folks are somehow gonna save the ED money when they are a big reason why we are spending money on nonsense in the first place.

I've seen an attending fail an LP after a senior couldnt get it. And seen people mismanaged by the ED literally every single day. Does that mean ED docs arent competent? Of course not.

And your EM intern year october argument is beyond silly and discredits you.

 

[Kach]

The argument for the FM fellowship pathway is that you can get the clinical experience you need for the ED outside the ED. You can learn how to manage rapidly decompensating patients on the floor and in the ICU. You can learn to diagnose and disposition initially vague patient complaints in the clinic. You can learn to manage a laboring patient on the labor deck.

If you are seeing the same pathology and doing the same procedures you have the same education, regardless of which room of the hospital you train in. Is there such a gap between what an FM and an EM sees in residency that it takes more than a 1 year fellowship to fix it?

Well said.

 

[Perrotfish]

I've seen an attending fail an LP after a senior couldnt get it. And seen people mismanaged by the ED literally every single day. Does that mean ED docs arent competent? Of course not.

And your EM intern year october argument is beyond silly and discredits you.

I
I have never seen an attending miss an LP. Only interns miss LPs. Seniors have dry taps and attendings have incompetent assistants, but only an Intern actually misses.