Random FM/EM Dual Residency Questions.

[KeikoTanaka]

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I'm interested in both FM and EM. I'm always going back between the two. This forum is plagued with individuals looking to do FM but want to do EM, and the response is typically: "That is unsafe and not fair to your patients" - So, to work around this, I am actually really interested in just biting the bullet and doing a 5 year FM/EM combined residency. I like the idea of working with kids a bit more, hence why I'd be more interested in FM/EM rather than IM/EM.

So, my questions are as follows:
1. Lets assume I don't get accepted to an EM/FM dual residency - Everyone always brings up EM fellowships for FM Docs. But do FM fellowships for EM docs exist reciprocally? I've never seen this question asked, and I can't google it because the moment you type in "FM Fellowship" you only get links to fellowships a FM Doc can do.

2. Lets pretend I did get accepted. I would want to work mostly EM while I'm younger to make more money to pay off loans while transitioning more to doing FM as I got older. However, it would be unfair to my patients if I was not keeping up with my FM skills. So, is it "possible" to be super-part time as a FM Doc (only working 2 days a week) and also do per-diem EM work, doing 2 shifts a week? Assume my husband is also a physician and is full-time and providing us with things such as health insurance. This may be a better question on the ED forums as I'm not sure how per-diem EM pay works or how it differs from part-time and if its a prevalent thing seen at most hospitals.

3. Instead of working OP as a FM doc part-time while doing EM shifts, would you be able to maintain those FM skills doing Hospitalist work instead, or is it not really the same? I am thinking that Hospitalist work may perhaps be a better route to take in that there is more flexibility in those shifts, so working ED and hospitalist shifts in together would be more manageable. If you were part-time Hospitalist and part-time ED at the same hospital, could you qualify as being "Full-time employee"?


In my mind a single ED shift pays more than a single OP FM shift, so theoretically 2 OP FM shifts and 2 ED shifts would be more money wise than 4 OP FM shifts? However, I'm not the best at understanding physician reimbursement so I could be wrong in this thinking.

Sorry, I know this EM/FM discussion appears on this forum ad nauseum, but I feel like these are unique questions about an actual feasible practice model, rather than a potentially "unsafe EM fellowship" that doesn't prepare you to fully be working in an ED.

Also, before people say this is a stupid gimmick and people typically only enter these programs to go on to doing administration, know that I love variety and would gladly accept a pay cut to do what I want to do rather than just sacrificing one for the other to make more money.

 

[martvubo]

I'm sure you will get plenty of feedback about half-assing two things instead of whole-assing one thing so I'll leave that to more experienced people, but on the outpatient side as a former patient of someone doing something similar, I will say having my PCP only available 2 days a week was eventually frustrating enough to change doctors, and I doubt that preference is unique to me.

 

[deleted480308]

There are no FM fellowships for EM docs that I am aware of

There is almost always someone willing to hire somebody part time if they can pay them low enough wages, a large system might absolutely be willing to hire a doc to always cover fridays or be a floater to cover absences but if you graduate residency and then practice fm 4-8 days a month you won’t be that good in the same way that you cannot work 4-8 Em shifts a month right out of residency and stay any good

 

[InternistDO]

1) Like sb247 said, there are no EM--> primary care fellowships. You can likely work in some poorly staffed free clinic/FQHCs with EM boards only, but much like working in the ED with FM training, you'll be behind the 8 ball. You can always go back to FM residency, which would be another 2.5 years.

2) As others have said in the past, the issue with part time FM is you make it very inconvenient to maintain continuity of care since you're only available a few days a week. Most FM doctors who work part time work in urgent care or similar clinics which are basically the same as working the fast track pod of an emergency department (in which case--why spend two more years doing FM?). Something like sports medicine is much more amenable to only being available a few days a week.

3) Hospitalist work is not the same as outpatient FM--in fact, I would say EM is much closer to outpatient primary care than hospital medicine is. It would however, be much easier to do part time hospital medicine as opposed to primary care. As far as being a full time employee it completely depends on how the staffing model in the hospital is set up.


I also vacillated between FM and EM. At the end of the day I realized I liked the idea of being an FM doctor more than I actually liked the work of family medicine, so I'll be doing emergency medicine. I think some of this can be SDN/Reddit related--EM is a very popular specialty online and so we can hear a lot about it, but we also hear the same bad sides to the specialty over and over again. Meanwhile, the few FM doctors who post on SDN tend to be very content with their jobs, and this can give the illusion that EM is a cesspool of burnout while FM is a magical wonderland when in reality the specialities fare pretty similarly on rates of burnout and satisfaction.

Judging by some of the questions you've asked I'm guessing you haven't done clerkships yet. While they did not completely clear up my career anxieties, everything will become much more clear when you start to rotate clinically. Lots of people were 100% sold on primary care until they actually had to do primary care. Me, I thought about doing surgery until about 2 hours into my first surgical clerkship. FM and EM are very similar in that you see the greatest variety of patient presentations throughout all ages and pathologies, but they could not be more different in how they approach patient care.

I know you'll continue to stress about this regardless of what I say (since I did the same thing), but I promise no decision you make now will have any impact on what you actually end up enjoying in "real life".

 

[Ironheme]

Or do FM outpatient locum rather than a steady practice to keep the skills sharp...I'm sure OP could find a place where they're filling in for an FM doc every so often.

 

[Mt Kilimanjaro]

Had a similar dilemma, chose family medicine mostly because it provides more varied clinical options long-term and I have zero interest in living near a large city.

I think the more rural you go the better chance you have of having something similar to the arrangement you described above. If you want to live in near big city and do FM, probably would have to do urgent care or travel to a more rural area for locums ED work, but certainly doable.

 

[Atlas Shrugged]

The other component of FM vs EM is that with FM you can work anywhere, in any setting. EM requires an emergency department and hospital (FSED are a thing, but it is arguable that they should be or will be for much longer).

 

[KeikoTanaka]

The other component of FM vs EM is that with FM you can work anywhere, in any setting. EM requires an emergency department and hospital (FSED are a thing, but it is arguable that they should be or will be for much longer).

There aren't many places I want to live in which an ED is more than 30 minutes away lol

 

[Atlas Shrugged]

What I’m saying is you can work for yourself, even in the city. You do not need a hospital. You can charge cash only in an office with minimal ancillary staff. Or you could work for a hospital. There are options.

An ED physician needs an ED.

 

[caskettcase94]

Have you ended up making a decision either way or finding any better answers to your question OP? I'm an M4 with this same dilemma getting ready to apply in a month.

 

[KeikoTanaka]

Have you ended up making a decision either way or finding any better answers to your question OP? I'm an M4 with this same dilemma getting ready to apply in a month.

I wish I could help you. I'm only an M2. This was purely for curiosity, but, I'm glad to say the year of school has actually changed my mind a bit in that I'd also be open to doing IM/EM in the future. But, we'll see if I even like EM in my rotations haha. I've scribed in the ED before and was overwhelmed, but it was also my first scribe job ever, so there was also a learning curve there.