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peds ER

Discussion in 'Emergency Medicine' started by Gleevec, Mar 29, 2004.

  1. Gleevec

    Gleevec Peter, those are Cheerios
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    Ive read some of the old threads on peds ER and had a couple more questions.

    How common/competitive are peds ER programs?

    What are the hours and pay like for peds ER, especially in comparison to other ER programs? Is there are demand for peds EPs?

    Are they generally considered a branch of pediatrics, or a part of ER (I know that there are different paths to becoming a peds EP, but is the department autonomous, part of ER, or part of peds?)

    What are the differences in the kinds of disorders you generally treat?

    What are the advantages/disadvantages to peds ER versus ER or peds?

    Id really appreciate any replies! Thanks in advance!
     
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  3. Seaglass

    Seaglass Quantum Member
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    For EM/Peds dual residency - relatively uncommon, probably same competitiveness as reg. EM. Can see anyone reg. EM doc can.

    For Peds then EM fellowship, probably middle road of competitiveness, still rather uncommon. Can't see adults.

    Hours are the same, pay is the same or somewhat less (you can't bill for the expensive things like procedures critical care since most visits will be primary care type issues, at least that was how it was explained to me). There is a demand but mostly in academic childrens hospitals.

    Depends on the institution, but usually part of the ER.

    You see kid stuff - URI's, newborn with fever, worried mom, worried dad, etc. You're not seeing sepsis, CHF (usually), MI (usually) etc.

    Disadvantage over straight ER: You're likely to get put into just peds shifts if you're EM/Peds or forced into just peds if you're peds-em fellowship trained. As stated above this can mean lower reimbursement and lower pay. I also think it's more monotonous versus a normal EM practice. Also, as a BC EM doc you are already fully qualified to treat children in the ER, so why do the extra training when it doesn't really add anything to your overall practice? I can only see doing this if you didn't want to see adults anymore.

    Advantage over Peds: No clinic, higher pay probably, shiftwork.

    Hope this helps. No doubt someone will be along soon to correct any errors.

    C
     
  4. Pelivar

    Pelivar Brain donor
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    I disagree with some points cg115 made but we both have peripheral knowledge so take answers with a grain of salt. I applied to Peds/EM this year so I asked 50 people these questions.

    Peds/M combined residency - only 4 spots so competitiveness varries a ton year to year depending on how many apply and how strong the applicants are.

    Peds then Peds EM fellowship- one of the most competive pedsa fellowships, some poeple I talked to had to apply for a few years before they could get in.

    EM then Peds EM- a little easier and only 2 years (vs 3 for peds)

    Peds EM hours are the same as adult EM hours (shiftwork, around 40's per week). Most jobs for fellowship trained Peds EM people are in childrens hospitals and academic centers and pay tends to be less than aduly EM. Graduates of combined PEDS/EM residency make about the same or a little more than pure EM and get a lot of job offers. One recent graduate of Indy's program had 9 job offers vs 2-3 for most graduates. More dedicated Peds ED's are popping up so the demand is good for Peds ER. If you join the Peds ER listserve you'll see all the jobs being advertized.

    Peds ED's are usually part of the peds department. Most community and academic ED's still have a combined ED where childran and adults are seen together so then it is under EM.

    I agree with most of what cg1155 said here. Most combined peds/ER residents work in academic centers where they see adults and children, go into academic EM programs and be the peds expert, or work in the community and see both adults and children. They are not fellowship borded so they usually do not work in dedicated peds ED's. You do see some high acuity patients in Peds EM but less than adult.

    Pelivar
     
  5. Seaglass

    Seaglass Quantum Member
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    That's interesting Pelivar. Most of the places I have visited the Peds ED was a part of the EM Dept. unless it was part of a large free-standing childrens hospital. Just goes to show you the variability un praactice environments and arrangements.

    C
     
  6. trauma_junky

    trauma_junky 12 step pre-med rehab
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    I worked in the pedi ER in San Antonio. They did a 3 year pediatric residency and then a 3 year fellowship. But they all stated that you get a better pediatric understandeing doing a pedi IM residency.
     
  7. frog4brooke

    frog4brooke Member
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    When I was doing my research I spoke with several Peds EM attendings who had chosen to do the Peds then Peds EM route, but many of them said that on the job market I would be much more competitve with the EM then Peds Em fellowship.

    For me, I liked this better because residency is a long hall-if something happens I would much rather work in the ED then be a general pediatician.

    Most Peds EDs are still in academic settings. I have seen a mix of big EDs with little part dedicated to peds and hospitals with 2 entirely sepparate EDs (one adult and one Peds), as well as peds hospitals with their own EDs.

    P-is totally right the Peds EM fellowship is one of the harder ones to get for someone who is Peds trained. Currently the Peds EM fellowship is 2 yrs for EM folks-but in the future politics may dictate that it is 3 for all. Also right now the combo Peds/EM forlks cannot sit for the Peds EM boards-What does it mean? probably not a lot.

    As for who is trained best for Peds Em it depends on who you ask-ask a peds person guess what they will say? When I was interviewing for residency, knowing that I will want a peds Em fellowship I looked at the amount of time that each place spent on peds rotations-Is there a NICU and a PICU month that sort of thing. I also looked to see which had Peds EM fellowships affiliated-Would it be possible for me to stay in same city for fellowship and not move? How much time would I get to spend with Peds EM trained folks?

    Every April the journal of Pediatric Emergency medicine posts a list of fellowships. also SAEM has a list. There are a couple of list servs out there, too.

    Probably more info then you needed, but I hope it helps!

    F4B
     
  8. Apollyon

    Apollyon Screw the GST
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    I looked at it a while back, and, as for Peds EM, about half of the spots for EM-trained residents were 2 years, and the other half were 3 years. I was thinking that having half the fellows only having to do 2 years, with the other half required to do 3 might engender some animosity.
     
  9. Pelivar

    Pelivar Brain donor
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    Going along with what F4B said, a couple Peds EM people told me that spots might be advertised as 2 years but you'll be pressured into doing 3 years (usually a 3rd research year) because the peds people have to do 3 years. That is a lot of years to make the same or less money when you can already see kids in the ED after EM residency.

    -P
     
  10. Gleevec

    Gleevec Peter, those are Cheerios
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    That is what I was curious about. It seemed as if ER docs already see kids as it is. I was sorta confused on the place of peds ER in relation to ER in that regard, and perhaps am a bit moreso now if peds cases are taken to the regular ER docs.
     
  11. Seaglass

    Seaglass Quantum Member
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    Yeah, the place for Peds EM docs is in dedicated Peds ED's. In my experience they never work the main ED unless they are trained via the EM->Peds route. Of course since the majority of ED's are integrated adult/peds there isn't a huge demand for peds->EM trained people in general practice.

    C
     
  12. Kalel

    Kalel Membership Revoked
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    IMO (and I know that many community ER docs will agree), most EM residencies do not prepare you very well to deal with sick or well kids. I think that some programs only have their residents spend a few months in the PICU and peds ER side, and that's it. Many ER's currently employ pediatricians who are not board certified in ER because the ER docs aren't comfortable with kids and also because most of the stuff kids tend to come into ER's for these days (especially in cities) is primary care stuff. I guess this probably only worsens the problem as well, since if you don't see kids for a while in practice since they are being shuttled off to the peds center, you will become even less comfortable seeing them in the future when you are further away from your limited peds training during residency.
     
  13. Apollyon

    Apollyon Screw the GST
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    If they are EM-trained, community docs should be good with peds, and, likewise, most EM residencies have about 20-25% of all ED shifts being peds (with dedicated months and/or a percentage of shifts per month).

    Peds experience is an important question for many applicants, because ~30% of all ED visits are for peds. In my opinion, most EM residencies do prepare you anywhere from somewhat to very well to deal with sick (rare) or well (vastly) kids.
     
  14. Seaglass

    Seaglass Quantum Member
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    yeah Kalel, I'd say this is a dated opinion. I will say that peds training was a key factor when I was interviewing. At the program I matched at we have integrated peds shifts in the Peds ED whenever we are on an ED month as well as unit months. Most EM physicians I talked to felt that they were very proficient taking care of children, even those at non-residency ER's.

    I'm not saying that ED docs know as much Peds as pediatricians of course, but we are good at what we do.

    C
     
  15. Pelivar

    Pelivar Brain donor
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    I second what CG and Apollyon said. Peds experience is important to me as well and most residencies give a lot of peds exposure. It's like anything, if you see sick kids regularly than you will be good at it and feel comfortable with it. Some ER docs never treat kids and they lose the skills they had. The problem with pediatricans in the ER is that they are more suited to see the mildly children. If a child comes in crashing and you need to intubate, get lines in, resusitate then an EM doc would be much more capable and better trained to handle that situation. You need to be able to tell if the kid is sick (needs immediate treatment) or not sick and can be refered to their pediatrican. I would rather have someone working the ER who could handle the worst case and be a little less trained on how to treat URI's and rashes. That is where Peds ER comes in, they know the easy stuff and they can handle the worst case.

    -P
     

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