Homunculus said:
the general pediatricians working peds ED have been grandfathered in, and the trend now is toward EM fellowship trained pediatricians. sorta like ED's prefer ED docs instead of FP docs (if given the choice), peds ED's will prefer peds +EM fellowship, if for no other reason than to be true to the profession
seriously though, a lot of
peds ED is bread and butter peds residency stuff that we deal with daily for three years-- vs an
EM residency that will have rotations in peds ED or the random peds cases that come into their traditional ED's. i know i'd prefer
peds +peds EM fellowship than EM + peds EM fellowship for my kids, simply due to having more peds experience.
We rotate side by side with our colleagues in the Peds ED, and one thing they CANNOT do is trauma - even the ones that want to founder, and, when an EM person is available, >9/10 just yield to them. You're right about a large part of peds ED being basic peds, as in Peds ED and Peds clinic - however, the EM RRC dictates 16% of total shifts be peds, and a total of 4 months of peds experience - from the ACGME:
Pediatric experience, defined as the care of patients less than 18 years of age, should be at least 16% of all resident emergency department encounters, or 4 months of fulltime-equivalent experience dedicated to the care of infants and children. The program can balance a deficit of patients by offering dedicated rotations in the care of infants and children. The formula for achieving this balance is a 1-month rotation equals 4% of patients. Although this experience should include the critical care of infants and children, at least 50% of the 4 months should be in an emergency setting.
Is it really that much of a difference, especially in a 3 year Peds EM fellowship, if a person's residency was peds or EM? I mean, as you say, a LOT of it is fundamental peds, which do not have a steep learning curve, as far as EM goes, and stuff like critical care and procedures are very similar in adults and kids (sutures, LP's, intubation), with the exception of having to math out doses (and which the Broselow tape bridges the gap). I rotated through the PICU with my Peds colleagues, and we all got the same nothing out of it (and
certainly none of us learned how to indvidually manage a generally critically ill child, with the majority of patients being bone marrow, cardiothoracic, and post-op/SICU types - if you didn't have it going in, you didn't get it while you were there), and then we all rotate through the peds ED.
For a peds ED, having a peds EM fellowship trained provider - regardless of the residency - is, in my opinion, more than enough. 2 or 3 years, day in and day out, of working in the peds ED trumps one or the other residency. For the general ED, the EM RRC strives to ensure that a BC/BE EM doc can see any and all patients that come through the doors - from 23 weeks gestation to >100 years old, from mutilsystem failure/cardiac arrest to no complaint/wants a sandwich.
Interestingly, there is a proposition that was introduced to ABEM last year that said that, to teach EM residents, you had to be EM trained (or PEM) - which would ace out the general pediatricians working in the ED. No legs for that, so far, though.