Just finished my em fellowship!

[SKaminski]

Hey Kach, thank you so much for setting up this thread. I am a second year family medicine resident, and I've been thinking about my future more and more lately. I know there is endless debate on FM + EM Fellowship Vs EM Residency, and I'm not interested in that. I'm just interested in understanding what my options are.

I have a few questions I hope you are willing to answer:

Beyond those few job offers at busier EDs that you mentioned in your original post, do you feel like your number of job opportunities to practice in ED has increased?

Do you feel the location of your ED job offers have expanded, specifically for medium sized cities? I'm not interested in living in LA or Phoenix, but some place like Boise, Idaho (with +/- 500,000) or Asheville, NC would be favorable.

Are you getting paid at a rate that is equivalent, or nearly equivalent, to your EM Residency trained colleagues?

Did you get board certified by ABPS? Again, i know this subject is slightly contentious, so I'm interested in two things related to this:

1) Did you get EM Board Certified by ABPS? Why or why not?
2) Have you had any hospitals reject your board certification if you did?

Again, thank you for your time.

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[Lexdiamondz]

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.

This is from personal experience precepting both EM interns and FM/IM PGY-2s. Most EM senior residents would probably agree with me - by October an EM intern functions better in the ED than the majority of FM/IM rotators.

 

[MedicineZ0Z]

This is from personal experience precepting both EM interns and FM/IM PGY-2s. Most EM senior residents would probably agree with me - by October an EM intern functions better in the ED than the majority of FM/IM rotators.

That's just like.. your opinion man. We've been over this. EM residency is gold standard. Most FM docs will not be capable of real ED work. Some will be and occasionally they will be as good as EM trained docs.
There's something called: talent. It plays a big role in determining how good you are at something

 

[MedicineZ0Z]

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.

Seen 2 EM attendings miss it on different occasions, both were BCEM.

 

[betamale]

Not that it truly matters but PAs do 100 weeks of graduate school and physicians do around 145-155 weeks so right at a year difference. You guys have summers off and other breaks. PA school we had 4 weeks off in 2 years. So 7 years for PAs and 11 years for MD or DO. Just making a point that your info is a little wrong. Now your training and 80 hours in residency do add up and your education is far superior to mine. I understand my role and know you guys are the captain of the ship. Does not bother me one bit. I just hate when people state that physicians go to school for 4 years and PAs only 2 years which is not true.

Personally, I feel like med student and PA student education are comparable. We do have the advantage in quality of our instructors but I feel like the end point is the same, which is basic medical education. I would support PAs earning MD with additional 1-1.5 years of rotations, lectures and passing core rotation NBME shelves and all the USMLE Steps especially PA students who graduate from schools that have MD programs. Conversely, MD students who opt to change roles into PA should be able to challenge PANCE after 3 yrs of medical school.

 

[Kach]

Hey Kach, thank you so much for setting up this thread. I am a second year family medicine resident, and I've been thinking about my future more and more lately. I know there is endless debate on FM + EM Fellowship Vs EM Residency, and I'm not interested in that. I'm just interested in understanding what my options are
No prob at all.


I have a few questions I hope you are willing to answer:

Beyond those few job offers at busier EDs that you mentioned in your original post, do you feel like your number of job opportunities to practice in ED has increased?
Yes, especially in bigger hospitals. I get more requests daily. But even as a FP, as long as youre willing to travel, there are plenty of EM jobs out there.

Do you feel the location of your ED job offers have expanded, specifically for medium sized cities? I'm not interested in living in LA or Phoenix, but some place like Boise, Idaho (with +/- 500,000) or Asheville, NC would be favorable.
ABsolutely. I think that the fellowship makes you ideal candidate to work in medium sized hospitals (20-50k) in medium sized cities (100-500k).


Are you getting paid at a rate that is equivalent, or nearly equivalent, to your EM Residency trained colleagues?
I’m pretty sure! 200-300/hr is what to expect. $200/hr for hospitals with <10k annual viists is ok. Dont take less than 250/hr at a bigger hospital. I havent figured out the RVU stuff yet but I suspect the RVUs will get you closer to $300.


Did you get board certified by ABPS?
Not yet, I’ve applied

Again, i know this subject is slightly contentious, so I'm interested in two things related to this:
1) Did you get EM Board Certified by ABPS? Why or why not?
I’m sitting for the ABPS written exam in 1 week. Ill take the oral next year. I took the board review sponsored by Center for Medical Education. Very succinct with a few big shots doing the lectures (Dr. Mattu, etc).

2) Have you had any hospitals reject your board certification if you did?
No, every job that my recruiter presented me to has asked me to sign on. I had to ask her to stop presenting me to more EDs.


Again, thank you for your time.

 

[Kach]

Seen 2 EM attendings miss it on different occasions, both were BCEM.

They are missed all the time. That is what IR is for.

 

[Kach]

Hey Kach, thank you so much for setting up this thread. I am a second year family medicine resident, and I've been thinking about my future more and more lately. I know there is endless debate on FM + EM Fellowship Vs EM Residency, and I'm not interested in that. I'm just interested in understanding what my options are.

1) Did you get EM Board Certified by ABPS? Why or why not?

I'm going for my BCEM for several reasons:
- I wanted to get my money's worth! I wanted something to show for the program other than the experience.
- Its a pretty plaque on my wall and a feather in my hat
- I've used it (and rightly so) to negotiate a higher salary
- I wanted to take the national oral/written exam to force me to standardize my knowledge through study.
- I wanted to update my existing medical knowledge.

 

[SKaminski]

Hey Kach,

Thanks for your answers! Based on what I'm reading and seeing, i'm leaning heavily towards doing an EM fellowship. What things do you think are important for me to do to have a strong application?

 

[Perrotfish]

Seen 2 EM attendings miss it on different occasions, both were BCEM.

I think you missed the joke

 

[Kach]

Hey Kach,

Thanks for your answers! Based on what I'm reading and seeing, i'm leaning heavily towards doing an EM fellowship. What things do you think are important for me to do to have a strong application?

I'm not sure what every program wants but in my program I know they valued the fact that I did so many em rotations, moon lighted in the uc as a resident and worked in the ed when I graduated from residency. They knew I was serious about em. I don't think they cared or even looked into my scores or anything. One of my other fellows was img so that didn't really matter either. They will interview your pd, for sure.

 

[hallowmann]

This is a joke right? I've seen so many EMs mismanage patients that it feels like a joke. I was also able to see as many patients as my EM counterparts (1st/2nd yrs not 3rd yrs). Were they bad residents or attendings, no.

Different people focus on different things, and as a result people have different skills. The point is having actually rotated through the ED actually gave me some insight as to why this was happening. EM residents don't get the opportunity to really go in depth and learn the full on management of genuinely medically sick patients. They didn't know much past the starting the insulin drip on that DKA patient, because they don't see it and are managing 5-7 other patients simultaneously, half or more shouldn't be in the ED in the first place, and dealing with ridiculous pushback from specialists. Add on 6-12 mos of additional inpatient medicine to their training and I'm sure they would be able to do the work.

I don't think many FM->EM fellowship people are looking to take the place of EM docs. They're looking to get more training in an area they're already working in. When there are enough EMs working in those Level 2s and Level 3s, then sure, most places will absolutely be taking the EM trained doc, but the idea that an FM doc with an EM fellowship wouldn't do at least as well as say the bottom half of EM graduates is ridiculous.

Not that it truly matters but PAs do 100 weeks of graduate school and physicians do around 145-155 weeks so right at a year difference. You guys have summers off and other breaks. PA school we had 4 weeks off in 2 years. So 7 years for PAs and 11 years for MD or DO. Just making a point that your info is a little wrong. Now your training and 80 hours in residency do add up and your education is far superior to mine. I understand my role and know you guys are the captain of the ship. Does not bother me one bit. I just hate when people state that physicians go to school for 4 years and PAs only 2 years which is not true.

A program I'm familiar with was 23 months, another was 26 mos, and yet another was 28 mos. Not sure if they had differences in terms of vacation time. Depth and expectations with training are the biggest differences in my opinion. Certainly time is different, but like you point out its not the only thing. It also has nothing to do with intelligence/being smarter as much as simply learning, and in turn knowing more depth. I see no problem with this because both physicians and PAs have different overall roles in patient care. You guys have a clear role in patient care, the big issue is when people try to argue they should practice equally as physicians, who have to go through huge hurdles just to practice independently even with the longer and more in-depth training. It just doesn't fit the roles they were trained for. To be fair, I see this argued more by NPs than PAs.

 

[Splenda88]

Different people focus on different things, and as a result people have different skills. The point is having actually rotated through the ED actually gave me some insight as to why this was happening. EM residents don't get the opportunity to really go in depth and learn the full on management of genuinely medically sick patients. They didn't know much past the starting the insulin drip on that DKA patient, because they don't see it and are managing 5-7 other patients simultaneously, half or more shouldn't be in the ED in the first place, and dealing with ridiculous pushback from specialists. Add on 6-12 mos of additional inpatient medicine to their training and I'm sure they would be able to do the work.

I don't think many FM->EM fellowship people are looking to take the place of EM docs. They're looking to get more training in an area they're already working in. When there are enough EMs working in those Level 2s and Level 3s, then sure, most places will absolutely be taking the EM trained doc, but the idea that an FM doc with an EM fellowship wouldn't do at least as well as say the bottom half of EM graduates is ridiculous.

The whole thing is about $$$... You can train and FM/IM doc in the ED for 1 year using a solid curriculum and they should be able to work in the ED with no issue because these fields have a lot of overlap. The same way if you give ED docs six months of inpatient training, they should be indistinguishable with a BC IM doc. For FM, they might need almost a year because of the OB/Peds component.

 

[Afrin]

Hey Kach,
Thanks so much for bringing this topic. I am currently a 2nd year FM resident. I just finished 100 hours rotation in a busy ER and I can't imagine how much I enjoyed it. I had no idea that I would enjoy ER that much compare all other rotations. I am an IMG and currently 51 yo. I also have an NP degree and worked as an NP hospitalist for 2 years prior to starting my residency. I am thinking now to pick at least two electives in the ER. I am also planning to moonlighting in the ER once I will be allowed in 3rd year. I also have an anesthesia elective rotation coming. I am hoping to learn as much as I can on my own interests and staying late in those rotations. I am seriously thinking about 1year ER fellowship after completing residency. Now my question is you stated you worked in the ER after completing residency, how long did you work in the ER prior to starting fellowship? If I want to work couple of years n the ER after my residency prior to starting fellowship would that be an option for me given that I am 51 right now. If I do work couple of years in the ER , then after that with 1 year fellowship, would that waste of time money wise other than definitely learning many new skills as you stated. I need to consider all these once again because of my age and I have a family of 4 to support. Finally how competitive would it be for me to get into ER fellowship if I wait couple of years after I complete my residency? Thank you so much for your time.

 

[FalseVanilla]

This debate is bonkers. We're comparing fresh grads. Who's better out of the gate? BCEM. Who's better after 10+ years of attending experience working in the ED? BCEM if we're talking level 1 trauma; they're probably equal if we're talking level 2-5. Seems like there will be opportunities for FM grads with a fellowship to practice EM. You just can't practice everywhere in the country and in every level as someone that is BCEM. If you can live with that then it's worth pursuing. If not being able to practice everywhere in every level infers that BCEM>BCFM+Fellowship...who cares? You're living your dream.

 

[Kach]

Hey Kach,

Thanks so much for bringing this topic. I am currently a 2nd year FM resident. I just finished 100 hours rotation in a busy ER and I can't imagine how much I enjoyed it. I had no idea that I would enjoy ER that much compare all other rotations. I am an IMG and currently 51 yo. I also have an NP degree and worked as an NP hospitalist for 2 years prior to starting my residency. I am thinking now to pick at least two electives in the ER. I am also planning to moonlighting in the ER once I will be allowed in 3rd year. I also have an anesthesia elective rotation coming. I am hoping to learn as much as I can on my own interests and staying late in those rotations.
Thats what my program liked about my resume. Good for you. I did 6 EM months and 1 anesthesia month in residency. I made friends with Anesth and often came in early to get more tubes. I moonlighted in the UC as a 3rd year and my first job was in the ED.


I am seriously thinking about 1year ER fellowship after completing residency. Now my question is you stated you worked in the ER after completing residency, how long did you work in the ER prior to starting fellowship?
2 years


If I want to work couple of years n the ER after my residency prior to starting fellowship would that be an option for me given that I am 51 right now.
Yes you can work in the ED after residency and without fellowship. Be willing to travel.


If I do work couple of years in the ER , then after that with 1 year fellowship, would that waste of time money wise other than definitely learning many new skills as you stated.
One does the fellowship for the sake of acquiring new and sharpening less developed skills. You WILL sacrifice a year of money. Whether it’s a waste of time is a personal call. For me, I would say it wasn’t a waste of time. But it was tough and at times painful because 1. I felt like a resident again, and 2. I kept reflecting on how much I WASNT getting paid, lol. Thankfully it was only 1 year. Shout out and respect to my specialist colleagues who sacrificed 2-5 years to pursue their fellowships.


I need to consider all these once again because of my age and I have a family of 4 to support.
Finally how competitive would it be for me to get into ER fellowship if I wait couple of years after I complete my residency?

I don’t know how competitive EM fellowships are overall. I suspect not as competitive because FMs don’t generally specialize. I think you can increase your odds of getting a spot by applying widely and focusing on newer programs who are desperate to staff their EDs. The good news is that there is no long amcas/eras process because these fellowships are not ACGME. It paper app and a phone call (at least at my program). I recommend going for a level 3 hospital with at least 50k ED traffic annually.


Thank you so much for your time.

 

[Afrin]

How many hours per week or how many shifts per month did you have to work during fellowship? Were you allowed to moonlight ? If they do allow how much time can you moonlight? I noticed many fellowships are in the SE areas, would you recommend any of these? Which part did you do your fellowship? Finally how was your pay in the ER prior to fellowship and how big is the difference pay wise after the fellowship?
Thanks again.

 

[Kach]

How many hours per week or how many shifts per month did you have to work during fellowship?
16 12s a month

Were you allowed to moonlight ? Yes

If they do allow how much time can you moonlight?
As much as you want. I did 10 extra shift a month

I noticed many fellowships are in the SE areas, would you recommend any of these?
I recommend programs with >50k pts a year, >level3, and affiliates

Which part did you do your fellowship?
South

Finally how was your pay in the ER prior to fellowship ?
Low to Mid 200s an hour.

and how big is the difference pay wise after the fellowship?
Mid 200s an hour though in a bigger hospital. There's Opportunity for time and half

Thanks again.

 

[Kach]

Has to be affiliates with abps so you can take their national Board exam

 

[MidwestPAC]

This is a joke right? I've seen so many EMs mismanage patients that it feels like a joke. I was also able to see as many patients as my EM counterparts (1st/2nd yrs not 3rd yrs). Were they bad residents or attendings, no.

Different people focus on different things, and as a result people have different skills. The point is having actually rotated through the ED actually gave me some insight as to why this was happening. EM residents don't get the opportunity to really go in depth and learn the full on management of genuinely medically sick patients. They didn't know much past the starting the insulin drip on that DKA patient, because they don't see it and are managing 5-7 other patients simultaneously, half or more shouldn't be in the ED in the first place, and dealing with ridiculous pushback from specialists. Add on 6-12 mos of additional inpatient medicine to their training and I'm sure they would be able to do the work.

I don't think many FM->EM fellowship people are looking to take the place of EM docs. They're looking to get more training in an area they're already working in. When there are enough EMs working in those Level 2s and Level 3s, then sure, most places will absolutely be taking the EM trained doc, but the idea that an FM doc with an EM fellowship wouldn't do at least as well as say the bottom half of EM graduates is ridiculous.



A program I'm familiar with was 23 months, another was 26 mos, and yet another was 28 mos. Not sure if they had differences in terms of vacation time. Depth and expectations with training are the biggest differences in my opinion. Certainly time is different, but like you point out its not the only thing. It also has nothing to do with intelligence/being smarter as much as simply learning, and in turn knowing more depth. I see no problem with this because both physicians and PAs have different overall roles in patient care. You guys have a clear role in patient care, the big issue is when people try to argue they should practice equally as physicians, who have to go through huge hurdles just to practice independently even with the longer and more in-depth training. It just doesn't fit the roles they were trained for. To be fair, I see this argued more by NPs than PAs.

Yes most PAs are 24 to 28 months but very little breaks. It is 3 years od education per the academic calendar. Again not to even say we are remotely close to you guys but to point out our education is not that much less and that much different. (Yes I know you take step exams etc). Moat PAs I know and on other major forums dont want independence just OTP (physician and PA agreement at the practice level). So we both talk and agree on how often the physician comes around the clinic and chart reviews etc. Now us being told to make it a one size fits all approach. The newer PA needs more oversight and the 25 year veteran PA probably doesn't need as much as the new guy. This is discussed at the practice level and not a blanket statement.

 

[MidwestPAC]

Hey Kach,
Thanks so much for bringing this topic. I am currently a 2nd year FM resident. I just finished 100 hours rotation in a busy ER and I can't imagine how much I enjoyed it. I had no idea that I would enjoy ER that much compare all other rotations. I am an IMG and currently 51 yo. I also have an NP degree and worked as an NP hospitalist for 2 years prior to starting my residency. I am thinking now to pick at least two electives in the ER. I am also planning to moonlighting in the ER once I will be allowed in 3rd year. I also have an anesthesia elective rotation coming. I am hoping to learn as much as I can on my own interests and staying late in those rotations. I am seriously thinking about 1year ER fellowship after completing residency. Now my question is you stated you worked in the ER after completing residency, how long did you work in the ER prior to starting fellowship? If I want to work couple of years n the ER after my residency prior to starting fellowship would that be an option for me given that I am 51 right now. If I do work couple of years in the ER , then after that with 1 year fellowship, would that waste of time money wise other than definitely learning many new skills as you stated. I need to consider all these once again because of my age and I have a family of 4 to support. Finally how competitive would it be for me to get into ER fellowship if I wait couple of years after I complete my residency? Thank you so much for your time.

@Afrin what medical school did you go to? How did you manage to work as a NP 2 years prior to residency?

 

[Afrin]

I am an FMG. I went through nursing and NP schools while pursuing my residency.

 

[Kach]

I am an FMG. I went through nursing and NP schools while pursuing my residency.

Wow

 

[MidwestPAC]

I am an FMG. I went through nursing and NP schools while pursuing my residency.

That didn't answer my question. Was wondering if you did one of those online medical schools for PAs and NPs I see around. What do you mean while pursuing you residency. So we were a FMG that couldn't place in a residency so you went to nursing school then NP school then finally got into a residency?

 

[Afrin]

Hey @ Midwest PAC,
I perfectly answered you that you asked. No idea what FMG means ? I am not going to tell you exactly which medical school I went through. You probably also have no idea how competitive is it to get in to a residency program? I went to nursing and nurse practitioner route to support myself as well as to make myself a stronger candidate for residency that did help me at the end.
Yes it's a long process that I went through that's why I used the term pursuing residency. I have no idea about the online medical school with the NP/PA school you are talking about.

 

[SKaminski]

@Afrin I believe that FMG means Foreign Medical Graduate, as in they graduated from a medical school in a different country, not carribean.

@Kach I'm in a rural program at the moment. I can certainly do nearly 6 months of ED second and third year due to me electives, but I am not allowed to moonlight in places where I am a resident. I think the closest thing I can do is moonlight at the urgent care. Additionally, we have a nearby city that we can do rotations at, i'll see what is available there. I think the additional experience at higher acuity ED's would be helpful. To give you an idea of how rural i am, the hospital i am a resdieent at is a Level III Trauma Center, and is the highest acuity trauma center for about 70 miles in all directions.

additionally, Kach, when you say they will 'interview' my program director, you mean they will call him on the phone to ask him about me?

 

[MedicineZ0Z]

Hey Kach,

Thanks so much for bringing this topic. I am currently a 2nd year FM resident. I just finished 100 hours rotation in a busy ER and I can't imagine how much I enjoyed it. I had no idea that I would enjoy ER that much compare all other rotations. I am an IMG and currently 51 yo. I also have an NP degree and worked as an NP hospitalist for 2 years prior to starting my residency. I am thinking now to pick at least two electives in the ER. I am also planning to moonlighting in the ER once I will be allowed in 3rd year. I also have an anesthesia elective rotation coming. I am hoping to learn as much as I can on my own interests and staying late in those rotations.
Thats what my program liked about my resume. Good for you. I did 6 EM months and 1 anesthesia month in residency. I made friends with Anesth and often came in early to get more tubes. I moonlighted in the UC as a 3rd year and my first job was in the ED.


I am seriously thinking about 1year ER fellowship after completing residency. Now my question is you stated you worked in the ER after completing residency, how long did you work in the ER prior to starting fellowship?
2 years


If I want to work couple of years n the ER after my residency prior to starting fellowship would that be an option for me given that I am 51 right now.
Yes you can work in the ED after residency and without fellowship. Be willing to travel.


If I do work couple of years in the ER , then after that with 1 year fellowship, would that waste of time money wise other than definitely learning many new skills as you stated.
One does the fellowship for the sake of acquiring new and sharpening less developed skills. You WILL sacrifice a year of money. Whether it’s a waste of time is a personal call. For me, I would say it wasn’t a waste of time. But it was tough and at times painful because 1. I felt like a resident again, and 2. I kept reflecting on how much I WASNT getting paid, lol. Thankfully it was only 1 year. Shout out and respect to my specialist colleagues who sacrificed 2-5 years to pursue their fellowships.


I need to consider all these once again because of my age and I have a family of 4 to support.
Finally how competitive would it be for me to get into ER fellowship if I wait couple of years after I complete my residency?

I don’t know how competitive EM fellowships are overall. I suspect not as competitive because FMs don’t generally specialize. I think you can increase your odds of getting a spot by applying widely and focusing on newer programs who are desperate to staff their EDs. The good news is that there is no long amcas/eras process because these fellowships are not ACGME. It paper app and a phone call (at least at my program). I recommend going for a level 3 hospital with at least 50k ED traffic annually.


Thank you so much for your time.

how many total tubes did you get and how many before you felt comfortable?

 

[Kach]

@Afrin I believe that FMG means Foreign Medical Graduate, as in they graduated from a medical school in a different country, not carribean.

@Kach I'm in a rural program at the moment. I can certainly do nearly 6 months of ED second and third year due to me electives, but I am not allowed to moonlight in places where I am a resident. I think the closest thing I can do is moonlight at the urgent care. Additionally, we have a nearby city that we can do rotations at, i'll see what is available there. I think the additional experience at higher acuity ED's would be helpful. To give you an idea of how rural i am, the hospital i am a resdieent at is a Level III Trauma Center, and is the highest acuity trauma center for about 70 miles in all directions.

additionally, Kach, when you say they will 'interview' my program director, you mean they will call him on the phone to ask him about me?

Sounds like a good plan! Yes they will call you program director.

 

[Kach]

how many total tubes did you get and how many before you felt comfortable?

Hundreds. seriously. And I kept learning new tricks along the way. Like using my waist to wedge the head in extension, or using the towel roll to help with extension or exactly how to hold the mac blade. Or remember to have the nurse elevate the bed to my height (6'1). And I also had to make mental adjustments when I was first introduced to glide-a scope. I even had to learn the calculation for tube size in children ... (age+16)/4, multiply times 3 for depth of intubation. lol. THe good news is I think this is one of the easiest skills to convince specialists to let you practice. THe tougher skill for me was central lines. I just didnt get enough in residency to feel comfortable. I've prolly got a total of 100 career lines (IJ and fem only) under my belt now. Im far more comfortable with them now.

 

[MidwestPAC]

Hey @ Midwest PAC,
I perfectly answered you that you asked. No idea what FMG means ? I am not going to tell you exactly which medical school I went through. You probably also have no idea how competitive is it to get in to a residency program? I went to nursing and nurse practitioner route to support myself as well as to make myself a stronger candidate for residency that did help me at the end.
Yes it's a long process that I went through that's why I used the term pursuing residency. I have no idea about the online medical school with the NP/PA school you are talking about.

I never said I didn't know what FMG means. I posted above that you were a FMG pursuing a residency but working as a NP. I figured it was Home as you were currently working as a NP. I understand that you had several years off between graduating med school and places into a residency. Good luck.

 

[Afrin]

@ Kach,
Couple more questions...
If I want to go for ER fellowship directly after completing my FM residency would it be difficult to get in? Would I be able to take BCEM board after I finish fellowship or do I have to work for few years in the ER before I would be allowed to take it? Do most of them who complete fellowship eventually become BCEM?
Thanks.

 

[VA Hopeful Dr]

@ Kach,
Couple more questions...
If I want to go for ER fellowship directly after completing my FM residency would it be difficult to get in? Would I be able to take BCEM board after I finish fellowship or do I have to work for few years in the ER before I would be allowed to take it? Do most of them who complete fellowship eventually become BCEM?
Thanks.

BCEM | Board of Certification in Emergency Medicine | ABPS

What is the Board of Certification in Emergency Medicine (BCEM)? The Board of Certification in Emergency Medicine (BCEM) provides board certification and re-certification for qualified emergency department physicians. This can include physicians who might be certified in family medicine or...

www.abpsus.org

 

[Afrin]

BCEM | Board of Certification in Emergency Medicine | ABPS

What is the Board of Certification in Emergency Medicine (BCEM)? The Board of Certification in Emergency Medicine (BCEM) provides board certification and re-certification for qualified emergency department physicians. This can include physicians who might be certified in family medicine or...

www.abpsus.org

Well, you have to work 5 years in the ER to be able to sit for BCEM exam. So with 5 years ER experience do you still have to have one year fellowship in order to sit for BCEM exam?

 

[Lexdiamondz]

Well, you have to work 5 years in the ER to be able to sit for BCEM exam. So with 5 years ER experience do you still have to have one year fellowship in order to sit for BCEM exam?

Mind you, this isn't BCEM from any widely recognised entity.

 

[VA Hopeful Dr]

Well, you have to work 5 years in the ER to be able to sit for BCEM exam. So with 5 years ER experience do you still have to have one year fellowship in order to sit for BCEM exam?

I don't believe so.

That said, bear in mind that ABPS board certification isn't widely recognized.

 

[Kach]

@ Kach,
Couple more questions...
If I want to go for ER fellowship directly after completing my FM residency would it be difficult to get in?
ALl of my colleagues were recent grads.

Would I be able to take BCEM board after I finish fellowship or do I have to work for few years in the ER before I would be allowed to take it?
No, you can take it right away.

Do most of them who complete fellowship eventually become BCEM?
I dont know but I recommend you become certified.
The acronym, BCEM means board certified emergency medicine. In order to become "BCEM" one must be accredited by a board. TO get accredited by a board you have to fill out a bunch of paperwork and take their tests. Our \residency trained EM colleagues take their exams through ABEM and AOBEM ,I believe. FOr the record I believe there are a number of other EM boards including SAEM and others. For Non residency trained EM's we have to take our board through american board of physicians and surgeons, ABPS.

in order to be eligible to take the ABPS board exam, ABPS required me to send them 10 case reports of EM level cases, ie trauma, emergency metabolic conditions, etc. They will reject your application if you send them urgent care cases. Anyway, in addition to 10 case reports, you need to have 5 years (7000 hours) of EM experience OR 1 year of fellowship (no longer 2 years). There are two tests necessary to board certification: written 400 question exam modeled after the ABEM exam (more on that later and an oral exam consisting 12 case simulations. the costs of certification varies based on whether you did a fellowship or not. I paid $250 to apply to take the test, $900 to take the written and Ill have to pay ~$1000 for the oral exam. Both exams are administered once a year. Recerts are once every 7 years, i believe. It costs another 1k.

 

[Kach]

WHen I was applying, There were around 30 EM fellowships around the country. This number is increasing every year. However, only some of them are affiliated with ABPS for board certification. I recommend doing an ABPS endorsed fellowship so there is some level of quality control.

 

[Afrin]

Thanks so much for this information!

 

[Afrin]

I will be graduating in 2021. When should I start applying if I want to go directly to this fellowship after completing my residency considering I don't have to go through ERAS?

 

[Kach]

I will be graduating in 2021. When should I start applying if I want to go directly to this fellowship after completing my residency considering I don't have to go through ERAS?

Call at the beginning of your senior year.

 

[Kach]

This was important so it was worth repeating.

Would I be able to take BCEM board after I finish fellowship or do I have to work for few years in the ER before I would be allowed to take it?
No, you can take it right away.

Do most of them who complete fellowship eventually become BCEM?
I dont know but I recommend you become certified.
The acronym, BCEM means board certified emergency medicine. In order to become "BCEM" one must be accredited by a board. TO get accredited by a board you have to fill out a bunch of paperwork and take their tests. Our residency trained EM colleagues take their exams through ABEM and AOBEM ,I believe. FOr the record I believe there are a number of other EM boards including SAEM and others. For Non residency trained EM's we have to take our board through american board of physicians and surgeons, ABPS.

in order to be eligible to take the ABPS board exam, ABPS required me to send them 10 case reports of EM level cases, ie trauma, emergency metabolic conditions, etc. They will reject your application if you send them urgent care cases. Anyway, in addition to 10 case reports, you need to have 5 years (7000 hours) of EM experience OR 1 year of fellowship (no longer 2 years). There are two tests necessary to board certification: written 400 question exam modeled after the ABEM exam (more on that later) and an oral exam consisting 12 case simulations. the costs of certification varies based on whether you did a fellowship or not. I paid $250 to apply to take the test, $900 to take the written and Ill have to pay ~$1000 for the oral exam. Both exams are administered once a year. Recerts are once every 7 years, i believe. It costs another 1k.

 

[SuckySurgeon7]

You mentioned an IM person in your cohort. Do you know if many of these FM —> ER fellowships are open to IM people?


How many lines, etc, did you get to do in residency compared to the fellowship?


If you are not going to work in a large ER but maybe want to cover the occasional shift in a small rural ER (20K volume annually, etc), do you still recommend the fellowship?

 

[Kach]

You mentioned an IM person in your cohort. Do you know if many of these FM —> ER fellowships are open to IM people?

Yes it's definitely open to IM.

How many lines, etc, did you get to do in residency compared to the fellowship?

About 50 in three years of residency compared to 50 I one year of fellowship. But I also got dozens of external Jugular lines and quite a few ultrasound guided brachial/cephalic peripheral lines which are all totally underrated skills.


If you are not going to work in a large ER but maybe want to cover the occasional shift in a small rural ER (20K volume annually, etc), do you still recommend the fellowship?

it's a personal decision. you don't need an ER Fellowship to work in the ER. I guess if you're only working in the ER occasionally it will probably not be worth it to do the fellowship. you can learn A LOT on the job from colleagues and from conferences. but if you want to make emergency medicine a career like myself you should think about the fellowship. However, it will cost you a year of money and time.

 

[GonnaBeADoc2222]

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.

No

 

[Hamhock]

This was important so it was worth repeating.

Would I be able to take BCEM board after I finish fellowship or do I have to work for few years in the ER before I would be allowed to take it?
No, you can take it right away.

Do most of them who complete fellowship eventually become BCEM?
I dont know but I recommend you become certified.
The acronym, BCEM means board certified emergency medicine. In order to become "BCEM" one must be accredited by a board. TO get accredited by a board you have to fill out a bunch of paperwork and take their tests. Our residency trained EM colleagues take their exams through ABEM and AOBEM ,I believe. FOr the record I believe there are a number of other EM boards including SAEM and others. For Non residency trained EM's we have to take our board through american board of physicians and surgeons, ABPS.

in order to be eligible to take the ABPS board exam, ABPS required me to send them 10 case reports of EM level cases, ie trauma, emergency metabolic conditions, etc. They will reject your application if you send them urgent care cases. Anyway, in addition to 10 case reports, you need to have 5 years (7000 hours) of EM experience OR 1 year of fellowship (no longer 2 years). There are two tests necessary to board certification: written 400 question exam modeled after the ABEM exam (more on that later) and an oral exam consisting 12 case simulations. the costs of certification varies based on whether you did a fellowship or not. I paid $250 to apply to take the test, $900 to take the written and Ill have to pay ~$1000 for the oral exam. Both exams are administered once a year. Recerts are once every 7 years, i believe. It costs another 1k.

Please, readers: realize that this poster doesn't even know the role of SAEM in the world of emergency medicine.

Is it important to know what SAEM is all about? Only a bit, for an EM doc...but it's crucial for a physician who is going to speak authoritatively about board certification in emergency medicine.

Please, readers: judge your sources wisely.

That said, two points:

1. I thinks it' great an FM grad who completed an FM-EM fellowship is describing the experience. I have recommended an FM grad to such a program -- and informed him to all of my concerns. I hope to hear from him soon.

2. "EM fellowship" for FM grads -- regardless of the number of chest tubes or intubations or resuscitations or thoracotomies -- will never re-create the weekly didactics and scrutiny from EM attendings -- and, importantly -- from EM residents next to you.

This should not be underestimated.

HH

 

[betamale]

The EM fellowships have didactics. One of the EM fellowships do didactics with ER residents

 

[deleted480308]

The EM fellowships have didactics. One of the EM fellowships do didactics with ER residents

Where is there an EM fellowship with an EM residency?

 

[Kach]

Please, readers: realize that this poster doesn't even know the role of SAEM in the world of emergency medicine.
Oh Lord. Again this is a family physician speaking to other family physicians about the EM fellowship. To the poster's point, to all of you that are interested in doing an EM residency, go an read up on SAEM.

Is it important to know what SAEM is all about? Only a bit, for an EM doc...but it's crucial for a physician who is going to speak authoritatively about board certification in emergency medicine.
Please don't take my posts as a disrespect to SAEM and any other specialty boards. They all play their important professional and political roles.
Please, readers: judge your sources wisely.

That said, two points:

1. I thinks it' great an FM grad who completed an FM-EM fellowship is describing the experience. THanks.
I have recommended an FM grad to such a program -- and informed him to all of my concerns. I hope to hear from him soon. Cool

2. "EM fellowship" for FM grads -- regardless of the number of chest tubes or intubations or resuscitations or thoracotomies -- will never re-create the weekly didactics and scrutiny from EM attendings -- and, importantly -- from EM residents next to you.
As I suspected, this post is not a sincere encouragement to FMs interested in the EM fellowship.
This should not be underestimated.

HH

 

[Kach]

To those interested in the EM fellowship, I've been fortunate enough to pass my emergency medicine boards through ABPS, the only board available to FM's interested in certifying in EM. But before I start please understand that an FM can certainly practice EM without ABPS certification and frankly without doing the fellowship. I decided to sit for the exam to standardize my knowledge, for board certification, and for the plaque on my wall.

Now, Just a little about the process. It's both time consuming and expensive. After the fellowship you'll need to turn in ten case studies of emergency level 1 conditions, ie strokes, dka, stemis, traumas, etc. The deadline is February. The application fee is $250 bucks The exam fee is a $1000. The whole process takes 2-3 months because if the board doesn't think your cases are up to par, they will ask you to submit new case reports.

Exam prep: Your experience in the ED and in the fellowship are helpful. For example, one of the questions on my exam was about coags for a snake bite. I answered the question based on my experience in the ED. There were many questions that I answered based on my experience alone. 2nd, I used a board prep exam called rosh review. I was later informed that peer IX was a more accurate exam test bank but I found out late in the game. THat said I had a good experience with rosh. It's got like 3000 questions of which I got through approximately 1500. I recommend it highly because of the volume of questions and for its succinct and well written explanations and drawings. It also give an estimate about whether you will pass or not and your expected score. It was 400 bucks for a 1 month subscription. 3rd, I went to the National EM Board Review put on by the Center for medical education. My fellowship paid for it. It was incredibly helpful in answering questions correctly on my question bank and overall confidence. It was very professional with hilarious and incredibly smart lecturers. I attended a review in Baltimore, but I believe they are all year round in multiple cities. All in all, I studied for three weeks. Unfortunately, ABPS only organizes allows you to sit for there exam once a year in august.

The exam: I took the exam in one of the national exam centers. The exam was 400 questions and 6 hours long. I got a lot more trauma questions then I expected. A lot of questions, were peculiar to EM, ie what is the the difference between level 1 and level 5 ED? A lot of environmental questions and some toxidrome (ie dumbbels, mad as a hatter, etc) questions that weren't exactly emphasized in FM. Lots of ortho and trauma stuff. Again, between the fellowship the board review and the questions, you will be prepared. TO pass one needs a 70% according to ABPS reps.

Next, my oral exam. That will be next spring. If I pass I will be board certified! I plan on participating in one of the live courses. more to come soon.

 

[MedicineZ0Z]

You see a lot of insecurity for some reason from ED personnel. Not sure why.