Options Outside Residency?

[kandc]

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I am a 4th year with an interest in ECC- I've applied for a rotating internship, and have been toying with the idea of residency throughout vet school.

The cons are I'm already burned out, worried about loans, and have a time intensive/expensive hobby that keeps me afloat mentally (horses). I think the internship is absolutely critical to my career because it keeps my options open after graduation if I decide to do a residency, and will also hopefully increase my earning potential afterwards. I do not have anywhere near the grades needed to be considered competitive for a residency (poor test taker).

Is there another path to ECC board certification? I love vent/dialysis cases, and really love the idea of getting boarded- I feel like the options to do clinical trials/talks would be better, and that is something that really appeals to me in the future.

 

[Doktor Timo]

I have two thoughts: First, doing an internship to keep your residency options open is probably smart. It's probably NOT smart to do it to increase earning potential, because there's really no evidence at all that internship-trained vets make more money in the long run. Plus you're starting in the hole already by missing a year of normal GP salary. So understand that you're taking that risk if you do an internship and then decide not to pursue residency.

Second, I have heard nothing good about the state of the ECC specialty. They seem to be cranking out criticalists right and left with no regard for whether the job market needs them. Not to mention that it's not that hard to get a job as an ER vet right out of school. So if you just love ER stuff, that may be the wiser choice in the long run.

 

[jmo1012]

If you have any future interest in a residency, it would be best to just go into a rotating internship after graduation. you are extremely unlikely to be considered competitive let alone land an ECC residency in the future without either a rotating or a specialty internship.

You will not be able to do dialysis unless you end up in a residency - that stuff is just to intricate for a non-specialist to end up getting into. Its not even terribly common among specialists due to the financial aspect of it. You might be able to end up at a general ER job helping with vent cases...maybe. But again, the brunt of that is done at specialty centers with boarded people around to manage the most of it, and many of those people are also training interns/residents, who will be involved preferentially over a general ER doctor.

It is becoming harder to get an ER position out of school without an internship. The places that are taking untrained grads are taking big risks in my opinion, and the classmates I have who were promised mentorship at these places have all been disappointed. Not saying that you cant graduate competently ready to handle an emergency load right out of school, but you have to be a pretty special person to do it and not flounder (I say this as someone who fields a lot of calls from people who are uncertain, and from people who wish they had had more training before getting themselves in over their heads. Again, I also recognize that there are people who can do it fine and well without extra).

As far as I'm aware, there is not another path to ECC outside of internship-->residency-->board certification. And honestly, their shouldn't be. I feel like I am drowning everyday in the amount of critical things I need to know, and I can't imagine that without being rigorously emersed and mentored, that someone can get to specialty level in our field. You can definitely do clinical trials and talks outside of board certification though.

 

[CalliopeDVM]

I the brunt of that is done at specialty centers with boarded people around to manage the most of it, and many of those people are also training interns/residents, who will be involved preferentially over a general ER doctor.

That really varies with location. I know of lots and lots of places without specialty centers and without training interns (and some of them even have ventilators, LOL). I know lots of very skilled emergency vets who aren't board certified, and many haven't even done an internship - those emergency clinics either don't have the funds to hire a ECC specialist, or can't attract one for various other reasons. There's lots of room for a vet to work in ECC without being board certified........just probably not in the dozen or so largest US metropolises.

 

[dyachei]

In my area there are a ton of non-boarded ER positions available. I get contacted every so often asking if I want to work as an ER doc.

 

[kandc]

I love dialysis and vent cases, which is why I'm still playing with the idea of residency.

I do, however, want to ride horses sooner, rather than later, and am concerned about paying down student loans (HILARIOUS).

 

[dyachei]

@LetItSnow you see vent cases, don't you?

 

[RadRadTerp]

That really varies with location. I know of lots and lots of places without specialty centers and without training interns (and some of them even have ventilators, LOL). I know lots of very skilled emergency vets who aren't board certified, and many haven't even done an internship - those emergency clinics either don't have the funds to hire a ECC specialist, or can't attract one for various other reasons. There's lots of room for a vet to work in ECC without being board certified........just probably not in the dozen or so largest US metropolises.

NYC is pretty big and most of the vets that work in ER at VERG and Blue Pearl are non-boarded vets. They tend to have 1 boarded emergency vet on staff, but they aren't always working. Many of the vets that work at these places were interns at these facilities and they like to hire internally from what I've seen.

 

[jmo1012]

I love dialysis and vent cases, which is why I'm still playing with the idea of residency.

I do, however, want to ride horses sooner, rather than later, and am concerned about paying down student loans (HILARIOUS).

Depending on where you do your internship and residency, you may have some time for horses. I could certainly make time where I'm doing my residency on my days off.

Everyone I talk to has differing opinions as to whether or not residency will be a good return of investment. In thoery, you're more likely to be working days and seeing referral cases where sicker patients are being transferred to you for care, so you are more likely to managing cases for multiple days rather than just quick out patient stuff. It depends on where you work and how compensation is set up as well. At my internship, the boarded folks for sure made a decent amount more than er because we was salaried. I could easily see senarios though where you would not make more though, so I think it ultimately ends up depending on what you want after residency and where you choose to live/practice

 

[LetItSnow]

@LetItSnow you see vent cases, don't you?

Not really, no. I'll short-term ventilate something as needed - and occasionally I'll non-ideally ventilate something on a simple surgical ventilator for way longer than I should - but for true long-term vent cases requiring AC/SIMV/PEEP/etc I transfer them to our BluePearl criticalist partners.

I agree with jmo that if you want to do vent and dialysis therapy, you need to pursue criticalist boarding. I'd caution someone who wants to pursue that to make sure they really understand how limited those therapies are in veterinary medicine - it's not like you'll be working vent cases every single day. Hemodialysis is only done at certain places in the U.S., so again - those are jobs that are tough to come by. Peritoneal dialysis, in theory, could be done in a more widespread fashion because the equipment needs are minimal, but due to associated cost just isn't terrifically commonplace.

So yeah, it can be neat stuff, and there are definitely times I've wished we had it available (especially certain toxins), but the OP needs to make sure they understand it's unlikely to comprise a majority of their time in clinics. It's just a cost vs other therapies vs availability vs prognosis problem in veterinary medicine. That said, when those therapies are needed, available, and you get the right owner, they can be super cool cases. I short-term vent'd a head trauma case once that I txfr'd off to critical care for longer-term vent therapy that turned around, recovered, and discharged. Awesomely satisfying case.

I disagree with jmo that getting an ER job straight out of school is hard - there are tons of job openings, and many places perfectly happy to hire a fresh grad. And, obviously, my own experience was going straight into ER work out of school. I am in a large-ish urban area (Minneapolis-St. Paul) and (almost?) none of the ER docs outside the university are boarded criticalists in this area. None of our doctors at our 7 hospitals are, and of the other ERs in the Twin Cities ... one of them has a criticalist, I think, but none of the others do. The 2 of our hospitals that are co-located with BluePearl have BP's criticalists available for transferring cases. So there are few criticalists here, and a ton of non-boarded ER docs.

Many ERs <do> prefer at least a year of experience or an internship, but there are plenty of us who have taken jobs without that, and looking backwards I don't regret it. If you're motivated and have experience in the ER environment, I don't think it's hard to find an ER job out of school.

I understand what jmo is talking about with working days and taking care of patients longer, but I'd probably phrase it differently. I read jmo's comments as implying ER docs don't deal with long-term patients, and that isn't accurate. I think what jmo meant is that criticalists don't really deal with quick out-patient cases like we do, and that seems to be true in my experience. But I hospitalize and maintain cases from start-to-finish very commonly. Even moreso at our outstate hospitals where more advanced care (usually IntMed) isn't available. Frankly, I transfer far fewer cases to a criticalist - if I'm transferring something, it is usually to Sx or IntMed.

One factor to consider for the OP or anyone else considering this route is that ER docs do more surgery than the criticalists, at least in my limited experience. If you like Sx, recognize that you won't get as much as a criticalist (though you can ALWAYS pick up shifts working ER if you like Sx). If you hate Sx, working critical care would be a good thing.

Someone in the thread mentioned market saturation with criticalists - I don't know if that's true or not. Jmo ought to know.

I don't really agree that places are taking a big risk hiring someone fresh out of school - I think it varies too much from graduate to graduate to make that generalization. There are 20-year experienced vets who would be a lot bigger risk than some new grads.... you just have to evaluate each candidate on a case-by-case basis, which is pretty easily done with some working interview days.

Bottom line for the tl;dr crowd: I agree with jmo - if you want to do dialysis and vent therapy, go do a residency. I also agree with Doktor Timo's response that the evidence says internships don't increase your earning potential long-term; they are best done for people who are a) uncomfortable going off into practice without more guided mentorship, or b) intending to pursue a residency where it is required. If the OP is considering a residency, doing an internship is a smart move. I don't know of any route that will get you doing dialysis and vent cases on a regular basis without residency. The one exception might be peritoneal dialysis - anyone with sufficient motivation could learn to do it. It would be tough to impossible to make a case for it to your management, though.

 

[pooter]

IME, there tend to be lots of non-boarded ER docs pretty much everywhere (besides the university hospitals), but how much you get to do varies widely depending on the practice. Dialysis is kind of pie-in-the-sky unless you're at one of the maybe half dozen places in the country that do it, and even then it'll be a specialist with letters after their name who takes point (and from what I've seen, those letters are usually DACVIM rather than DACVECC). As for long-term management of cases, a lot of that depends on clinic policy and the specialists/residents in house. I'm at a place without criticalists and we very rarely transfer inpatients to surgery or IM, so I do a ton of it. When I was job-shopping, I interviewed at places where all of the inpatients transferred to the criticalist or internist. For surgery, I don't know of a DACVS who wants to cut a GDV at 2 in the morning, but it seems to depend somewhat on the presence of surgery or ECC residents who "need" those cases. There are an increasing number of e-vets at specialty centers who don't cut.