Pediatric EM

[DeadCactus]

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I'm an MS1 beginning to think about what I want to do specialty wise. I've had EM at the top of my list of specialties to explore more and I'm 80% that whatever I end up doing, I want to put an emphasis on pediatric patients.

If I go the Peds EM route, I definately want to do an EM residency since i would want to still be able to see adult EM patients. I'm curious if it would be better to do a Peds EM fellowship or an EM/Peds dual certification. The dual certification sounds like a good route to go because I have an interest in public health and clinical research and the extra training in primary care and medecine seems like a plus for those interests. Also, if going the EM/Peds route, is it possible to talk with an EM program and see if something can be worked out to do both or do you have to find established EM/peds programs?

I know the Peds/EM subject comes up here a lot so I hope I'm not re-asking the same old question...

 

[ERNerd]

I'm an MS1 beginning to think about what I want to do specialty wise. I've had EM at the top of my list of specialties to explore more and I'm 80% that whatever I end up doing, I want to put an emphasis on pediatric patients.

If I go the Peds EM route, I definately want to do an EM residency since i would want to still be able to see adult EM patients. I'm curious if it would be better to do a Peds EM fellowship or an EM/Peds dual certification. The dual certification sounds like a good route to go because I have an interest in public health and clinical research and the extra training in primary care and medecine seems like a plus for those interests. Also, if going the EM/Peds route, is it possible to talk with an EM program and see if something can be worked out to do both or do you have to find established EM/peds programs?

I know the Peds/EM subject comes up here a lot so I hope I'm not re-asking the same old question...

With EM + Peds dual certification you would be very well-qualified to work in a pediatric emergency department, in my opinion. However, it seems like most dedicated pediatric emergency departments are staffed with Peds + Peds EM fellowship trained people, with EM + Peds EM fellowship a distant second. This is probably because more Peds-trained people choose Peds EM fellowship than EM-trained people. And EM + Peds dual certification is rarer still. Your best bet is probably to talk with your local peds ED director or peds EM fellowship director about pros and cons of various paths.

Also, in response to your question, to do EM + Peds residency, you would probably have to go through an established dual training program, for logistical reasons and for reasons related to federal subsidies for residency training. Generally, the government only subsidizes a single residency per medical school graduate.

 

[DeadCactus]

Bump, in hopes of any additional input.

 

[KidDr]

Bump, in hopes of any additional input.

Most dedicated pediatric EDs want to staff their shifts with peds EM trained docs. Like ERNerd already said, most of these people are peds + peds EM fellowship trained because there are simply more peds-trained people doing peds EM fellowships than EM-trained people. Some (many?) pediatric EDs also use general pediatricians to fill shifts, but their salaries are usually less than the peds EM trained people (with the exception being peds-residency trained people who did a lot of EM work, but no fellowship, and were grandfathered in back in the 80s and 90s). In the dedicated pediatric ED in which I work, we have a few peds + EM dual residency trained docs who (as far as I can tell) are on the same level (they can fill "lead doc" shifts) and make the same salary as the peds EM trained docs.

In terms of what you should do, it all depends on what kind of flexibility you want when you're done (both paths will take 5 years, so this shouldn't be a factor in your decision). Do you want to be an EM trained doc who has extra expertise in seeing children in the ED, and also has general peds as a "fallback" career? (in the event you decide you don't want to do EM anymore). Can you see yourself doing a 2 1/2 years of a general peds residency (lots of clinic, inpatient, call, rounding, relatively few procedures, etc)? Or would you rather do 3 years of an EM residency (ED shifts, procedures, mainly adult patients, some offservice rotations but overall much less inpatient time and rounding, etc) followed by a dedicated peds EM fellowship? The answers to these questions is really going to depend on your 3rd year rotations. If you do your peds rotation and love working with kids but hate all the inpatient work and rounding, EM + peds EM fellowship is probably the way to go. If you love both your EM and your peds inpatient rotations, a combined peds + EM residency may be the way to go.

Overall, given that there are only a few peds-EM combined residencies out there, the EM + peds EM fellowship route is going to be your most likely path, but if you're really interested in the combined residency, it's worth looking into.

 

[bubbles!]

I'm currently in one of the peds/EM residencies. My motivation for choosing this was similar to yours. I love general ED and can't imagine doing anything else but I also wanted to be an expert at managing pediatric patients and possibly work in a dedicated peds ED at some point. I have a strong public/international health interest as well, so I liked the broad skill set and primary care experience the double residency provides.

Since there are so few of us out there, there's not a big sample size to draw from. Most graduates of my residency either end up in community practice working in both adult and peds EDs or have stayed in academic EM/Peds programs as faculty. I know a few that work both as pediatrics hospitalist/general pedatricians and do ED shifts as well.

It seems, though, from the experience of recent graduates that the career possibilities are endless with the dual certification, even working in an academic pediatric ER that generally hires fellowship trained physicians.

A good starting place to see if the double residency route fits your eventual goals is to go to the websites of the Peds/EM programs (University of Maryland, University of Arizona, and Indiana University). Indiana in particular has a nice F.A.Q. section that highlights the pros and cons of dual certification. Click around the websites and take a look at where the alumni ended up and what kinds of jobs they're taking. Then look at some Peds-ER fellowship sites in regions you might want to live/work and take a look at the same thing.

Feel free to PM if you want more specifics!

 

[DeadCactus]

I was curious if anyone could comment on how competitive Peds EM fellowships are. Would it be necessary to consider the risk of passing up a EM/Peds residency only to not get into a Peds EM fellowship?

Thank you all for the responses, btw. I appreciate people taking the time to address the concerns of an MS 1 worrying about things that are 3 years away. 😛