Options For EM Doctors?

[Dr JPH]

Hey all. I was recently speaking to a physician who worked in an occupational health clinic.

He said he was an EM doc for 15 years before giving it up and moving into his private practice/occupational clinic lifestyle.

My question is, how does one do this?

Do you need to do a dual residency in EM/IM or EM/FP?

Can you simply "retire" from the EM end of things and go open a practice without being board certified in anything else?

From my experience in EM, 90% of it is things you will see in a private practice setting anyway and are not really hospital/EM cases.

EM is an interest of mine, but I also like the private practice setting or even clinic setting outside the hospital.

If I wanted to, say, become an EM doc as well as have my own practice, would this be feasible? What route would I need to take as far as residency (single, dual)? What type of lifestyle could/would this lead to as far as schedule? Anyone out there doing something like this now or contemplating it?

Also, how competitive are the dual residency spots? I know there aren't many of them. How competitive are EM residencies on average? (particularly in the Philadelphia/South Jersey/Delaware area)

Thanks!

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[Firebird]

I don't know the specifics of this, but a physician told me that with an MD degree, you can practice any kind of medicine you want to. She was a pathologist, and she said it would be legal for her to perform surgery.

However, she said that no one is stupid enough to do something like that. This probably doesn't really come close to answering your question, though. Cause I'm sure the person you're talking about is certified in their respective specialty.

But as a side note, many FP/IM people get hired to moonlight in the ER.

 

[PimplePopperMD]

As straight EM goes, with an MD you can practice as you'd like. PRACTICALLY SPEAKING, my understanding is that it is difficult to just hang a shingle and do clinic work, because

a) You will be unable to obtain hospital privileges

b) You will be afraid of malpractice, and it will be difficult to get insurance without being board certified (it used to be even if you were BE, it was okay) in IM/FP/peds

c) Medicare/aid will not reimburse.

Again, this is my understanding of it... Theoretically, practicing medicine with an MD. Practically, much more difficult. I imagine it would be easier if you choose to try a rural practice where they really need docs.

 

[ckent]

You can take a test and be a general practioner after one year of residency in any field in a lot of states.

 

[Goofy]

You sound like an excellent candidate for the joint ER/Med degree. This gives you an incredible amount of options once the predicatable ER 'burnout' sets in. You could even do a medicine fellowship down the line if you so choose. This is the absolute best way to do ER in my opinion, and it only takes 5 years.

 

[Burton]

One point to clarify: Are you sure he wasn't already an IM doc? If he was doing EM roughly 20 years ago, he was probably trained as an internist. I worked with an ER doc who was IM-trained, and he decided ultimately that he'd rather have a practice. I also worked with another guy who ran an Occupational Health Clinic at the same time he worked in the ER- he just did both part time. But again, older guy, IM trained.

Now that EM residencies are flourishing and the demand for EM Board Certification (thru EM residency only) is increasing, I would imagine that if you wanted to do that now, you would either have to do a combined program like has been said before, or you could always find a smaller ER to work in that will hire IM docs, then go start a practice if you get tired of it.

 

[Voxel]

I've always wondered if it really is necessary to get dual boarded in IM unless you wanted to subspecialize. Why can't the ER doc join or open an urgent care facility? It's 9-5ish and its no call because they are not your patients, just a place to get urgent care outside of the ER. That sounds like a reasonible alternative for the burn-out ER doc who wants to work predictable hours without any call/beeper. Let me know your thoughts.

 

[Olanzapine]

I know of a surgeon in Kansas who got tired of doing surgery so he is doing general practice/internal medicine now. All it takes is a test and one year of residency in any field; most states are happy to have another primary care provider.

 

[Dr JPH]

I like your thought, Voxel, and that sounds like what I'm interested in heading towards.

It wouldn't be so much for the "burn out" of EM, but more because I need to always be doing something different and the bigger the challenge the better.

Good point Burton, I wasn't aware of that fact.

Thanks for all the responses so far, I would like to hear from anyone who is maybe headed in the same direction, but further along in the process.

 

[DrQuinn]

My EM attending has been thinking about cutting back on his hours and doing more FP stuff, working with one of his buds at his clinic. More likely to be a walk/in clinic, though, otherwise there's a lot of reading to catch up on when it comes to HTN/DM management...

When I worked in the ED as an orderly back in college, the ED dept head did PT work as the medical examiner for the county too. I'm not sure how that worked out (in re: to training/residency/licensing)...

Q