kids in EM

[Powdermonkey]

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Hey guys and gals, I have a few questions about options post training as well as kids in the ER.

After you do a 3 or 4 year EM residency, what options do you have? I know there are some fellowships in EMS, toxicology, sports medicine, palliative care/hospice, and what i'm interested in, peds EM, among others. What other options are afforded to an EM boarded physician in case you want a change of pace or if you think you may want to eventually do some clinic type work or things like that?

Also, as far as kids go, how many of you deal with kids at all in your ERs? I'm pretty interested in kids, but EM is my first love and what I'm really drawn to, so I'm trying to decide how to approach the issue. Should I do EM-->PEM, peds-->PEM, just straight EM and work in a community somewhere that I'll get to see kids in as well?

I know its still a little early for me since I'm just a 2nd year, but I'm trying to get everything sorted out at least a bit so that I can plan my 3rd year electives and have enough time to research and plan my 4th year electives as well.

Thanks!

 

[docB]

Options for switching from EM into a clinic setting are limited. You can do it but all the people I've seen do it have gone into weight loss and cosmetic stuff. A fellowship may give you more options for clinic work depending on the fellowship. While some EPs do drift off into primary care remember that you won't be trained for that and an EP practicing primary care is the same as a primary care trained doc practicing EM, it happens but it really shouldn't.

The majority of EDs and EPs see kids. The national average is about 30% peds visits. Most jobs you look at you'll see peds.

 

[Powdermonkey]

docB, did you feel properly trained after your residency to deal with kids? I've just noticed upon my research that most of the EM residencies usually only have a handful or so of months over 3 years where they get to be in either a NICU or PICU or something like that.

 

[docB]

Yeah. You feel pretty comfortable dealing with the routine peds stuff that comes into the ED. If you really want to work in a dedicated peds ED, especially a large cneter that gets kids with complex pathology (eg. tetrology, post Fontan, etc.) then I'd do a fellowship.

 

[Peds2ER]

You will see kids in most Emergency Rooms in which you work. If you want to see only children and specialize, you've hit upon the two major options: Peds-->PedsEM or EM-->PedsEM.

Starting in EM takes you 5 years start to finish assuming a three year EM program. The advantage is you would be eligible to practice in a mixed ER setting (kids and adults) and your compensation would tend to be signficantly higher than doing kids only.

Starting in Peds takes 6 years start to finish. The major advantage for you would be that your Peds training would prepare you well to practice in a clinical pediatric setting since you've expressed some interest in dabbling in clinical medicine. The major disadvantage would be the difficulty practicing in a mixed ED setting and the lesser compensation that results in practicing in a Peds only ED.

 

[Stitch]

Since I work in a children's hospital, I'll add that the referrals we get from ED certified/trained physicians are generally well done and appropriate. I think they do a good job of recognizing the red flags and realizing what does and doesn't need to be sent out. But that's why you need proper (EM) training.

 

[Powdermonkey]

So it appears then that if I want to work with adults at all in EM I'll have to do the EM-->PedsEM route, and if clinical medicine is of any interest to me then the Peds-->PEM route would probably be better. Or one of the very few EM/Peds combined or an EM/IM then fellowship route if I'm a real glutton for punishment.

Does that sound correct?

 

[Jeff698]

I've just noticed upon my research that most of the EM residencies usually only have a handful or so of months over 3 years where they get to be in either a NICU or PICU or something like that.

Keep in mind that those months are the only "dedicated peds only" months. We continue to see boatloads of kids every month we're in the ED during residency.

Take care,
Jeff