Second residency in Emergency Medicine

[IM.MD]

Hi everyone,

I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. I'm planning to apply this coming September but, unfortunately, I don't have any letters of recommendation from Emergency Medicine physicians. Would my application be considered if I don't have LORs from EM physicians? I'm going to apply to most of the 256 EM residency programs to ensure I match.
It seems very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016. I guess, I could work EM shifts at small rural or VA EDs that the locum recruiters keep emailing me about but those seem to be staffed by non-ABEM boarded docs, so I doubt their LORs would be useful.

I would appreciate some advice. Thank you!

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[Tenk]

You’d be better off doing crit care at this point.

You absolutely have to have SLOEs to apply to EM. Without them your application will be DOA.

 

[Groove]

Agree with @Tenk Infinitely easier for you to do CC and/or pulm/cc fellowship as an IM attending. That would basically land you in an environment with just as many procedures if not more with higher patient acuity if that's what you're looking for. It would also be a more versatile career with a great deal more synergy and compatibility with your current work as a hospitalist. Do some soul searching before you jump though and make sure it would be worth the sacrifices.

 

[IMGASMD]

I don’t know anything about switching to EM after you’re already boarded. I wonder if you find those IM/EM combined residency and see if you can get some info?
EM by itself is 3 years. Maybe there is an IM/EM program out there which is welling to have cheap labor for sometime in exchange to train you in EM.

I also saw that you did ask about Pulm/CC. Which I think maybe a better path. And let me throw in another monkey wrench in the discussion, how about anesthesia?

 

[deleted547339]

I’m EM and CCM. If I were in your shoes and didn’t want to be a hospitalist, I would do PCCM or, as above, maybe anesthesia.

 

[IM.MD]

Thank you for your replies. I've thought about CCM but, ultimately, I'd be happier in EM. I rather work up an undifferentiated patient with some peds, ortho, trauma and OB in the mix than rounding on the same vented patient for 7 days in a row. Scheduling in EM, although not ideal, seems more flexible and conducive to normal life than the 7 on / 7 off in hospital medicine and CCM. It's difficult on you and your family when you are working 84 hour stretches every other week. I've thought about the 1 year non-ABEM accredited EM fellowships available to FM and IM docs or the 1 year on the job training offered to non-EM boarded docs by TeamHealth but I'd probably be underprepared.
I haven't considered anesthesiology

 

[AlmostAnMD]

I feel like SLOEs are for med students. If you're an attending, you've clearly shown you're capable of doing work for 3 years without burning down an entire hospital.

Seems like you could just get letters from your PD where you did IM, your current chair, maybe someone else and the worst thing you could do is not match.

I'm not a PD for EM, but if I were that's how I'd view it. I might be wrong though.

 

[carbonizedeyesockets]

If you work at a place with an EM residency, consider talking to their PD. If you trained at a place that had an EM residency, reach out to their PD for guidance. You aren't the first to do this, so they should be able to give advice or at least get you in touch with someone who can help.

 

[southerndoc]

I feel like SLOEs are for med students. If you're an attending, you've clearly shown you're capable of doing work for 3 years without burning down an entire hospital.

Seems like you could just get letters from your PD where you did IM, your current chair, maybe someone else and the worst thing you could do is not match.

I'm not a PD for EM, but if I were that's how I'd view it. I might be wrong though.

Entirely wrong. As someone who interviewed tons of applicants last year and participated in our institution's rank list, I can tell you that SLOE's are very beneficial and may cost you an interview if you don't have any. It's not just for students. It doesn't mean you have to rotate in EM again, but you should ask the EM staff at your ED where you rotated during you residency (not medical school) to write some SLOE's. You will also need a letter from your IM program director (an absolute must). Clear explanation in your personal statement is necessary.

You will be at a significant disadvantage compared to medical students because you've already used up your funding. Many institutions won't grant you an interview because of that. Not saying it's not possible though. Just going to be tough. You'll need to be on top of your application.

Once you get an interview, you're pretty much in the general rank pool.

 

[AlmostAnMD]

It doesn't mean you have to rotate in EM again, but you should ask the EM staff at your ED where you rotated during you residency (not medical school) to write some SLOE's.

I dunno. Maybe different strokes for different folks. Our program just took a surgeon the year I left. I saw her app. No SLOEs. She did match there without problem.

Also, when you think about it, what you're asking for is impossible. What kind of quality SLOE will someone get asking for a letter from a one month rotation > 3 years ago? Come on.

I mean, I don't want to start a SLOE debate, they're great and valuable, but in situation specific things like someone out for years in another specialty let's not S the D of SLOEs

 

[WildcatS11]

I dunno. Maybe different strokes for different folks. Our program just took a surgeon the year I left. I saw her app. No SLOEs. She did match there without problem.

Also, when you think about it, what you're asking for is impossible. What kind of quality SLOE will someone get asking for a letter from a one month rotation > 3 years ago? Come on.

I mean, I don't want to start a SLOE debate, they're great and valuable, but in situation specific things like someone out for years in another specialty let's not S the D of SLOEs

to piggy back on this - a SLOE is only meant for an MS4 competing a rotation. You can’t compare an attending IM doc to medical students (which is what would happen if they did a rotation and had a SLOE filled out). If you want to do another residency (which is nuts) talk to your local EM PD, get some specific advice, and apply like crazy with regular LOR’s.

 

[brycew85]

"I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. "

consider family med!

- more spots and programs so you can be more picky and rank the ones that fit your geographical desires/educational needs (eg - dont have to move far, more ED rotations at bigger EDs, more OB focused, etc)

- easier to get in so you dont have to worry about SLOE's, spending a ton of money on applications not matching, etc

- Unlike EM where you may get a few months of credit for your CCM rotations in residency, in FM you'll get alot more for all those ward months + other electives you did in IM residency - at least a year if not more. this gives you more time to be in the ED, do peds and OB, etc. Family docs do work in smaller EDs but if you want more acute patients you can do a 1 year EM fellowship (also easy to get in) allowing you to work at bigger EDs. so basically 2 years of FM residency + 1 year of EM fellowship instead of 3 years of EM residency

and if you get burned out from EM work you can always go back to being a hospitalist or outpatient clinic seeing patients of all ages!

your post reminds me of this guy: I wish I had done family medicine

 

[Old_Mil]

Hi everyone,

I'm interested in pursuing a second residency in Emergency Medicine.

I would appreciate some advice. Thank you!

Don’t do it.

Crtitical care fellowship. Put the entire system to work shielding you from BS.

Thank you for your replies. I've thought about CCM but, ultimately, I'd be happier in EM.

You only think so because you haven’t done it yet.

 

[Lexdiamondz]

"I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. "

consider family med!

- more spots and programs so you can be more picky and rank the ones that fit your geographical desires/educational needs (eg - dont have to move far, more ED rotations at bigger EDs, more OB focused, etc)

- easier to get in so you dont have to worry about SLOE's, spending a ton of money on applications not matching, etc

- Unlike EM where you may get a few months of credit for your CCM rotations in residency, in FM you'll get alot more for all those ward months + other electives you did in IM residency - at least a year if not more. this gives you more time to be in the ED, do peds and OB, etc. Family docs do work in smaller EDs but if you want more acute patients you can do a 1 year EM fellowship (also easy to get in) allowing you to work at bigger EDs. so basically 2 years of FM residency + 1 year of EM fellowship instead of 3 years of EM residency

and if you get burned out from EM work you can always go back to being a hospitalist or outpatient clinic seeing patients of all ages!

your post reminds me of this guy: I wish I had done family medicine

This doesnt make sense

Doing 2 yrs of FM + 1 yr of an unaccredited and unregulated EM fellowship will only reliably give you the chance to see kids and maybe basic OB on an outpatient basis. Any job that requires BCEM (basically most jobs nowadays) will not accept an FM+EM fellowship

 

[DeadCactus]

I would do some moonlighting at an underserved emergency department. Many will have a few EM board certified physicians in the rotation and often the medical director is an emergency physician. This will give you a chance to do some soul searching and make sure you both want and need to do an emergency medicine residency while getting a relevant letter. A letter from your old PD and your hospitalist work would round things out. If your old residency or medical school can get you a SLOE, I would submit that too. At the very least it will check a box.

Really, I think you're going to need to focus on networking. You need an emergency medicine physician, preferably an academic one and preferably a program director, to go to bat for you.

I will add that, and I have a generally positive perspective on EM and pursued it for many of the same reasons you cite wanting to pursue it, you would objectively get more bang for your buck going the PulmCC route.
- Both are three years. PulmCC is 3 years of being 2nd in command with interns and residents to handle the busy work while you learn and do the fun stuff. EM is 3 years of being the minion. (Maybe you can get down to 2.5 years for an EM residency but likely you'll just get more elective time.)
- After fellowship, you're a relatively rare and respected subspecialist and have invested equivalent time as your peers. After an EM residency, you'll have twice the training of your peers with few tangible benefits and still generally treated with disdain and contempt.
- As you progress in a PulmCC career, you can shift toward academic or consult/clinic based work. As you progress in an EM career, there is no real progression.

Not that everything comes down to objective measures but some food for thought. If you really want more breadth in your practice including OB and peds while focusing on undifferentiated patients, then PulmCC isn't going to scratch that itch.

 

[Splenda88]

"I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. "

consider family med!

- more spots and programs so you can be more picky and rank the ones that fit your geographical desires/educational needs (eg - dont have to move far, more ED rotations at bigger EDs, more OB focused, etc)

- easier to get in so you dont have to worry about SLOE's, spending a ton of money on applications not matching, etc

- Unlike EM where you may get a few months of credit for your CCM rotations in residency, in FM you'll get alot more for all those ward months + other electives you did in IM residency - at least a year if not more. this gives you more time to be in the ED, do peds and OB, etc. Family docs do work in smaller EDs but if you want more acute patients you can do a 1 year EM fellowship (also easy to get in) allowing you to work at bigger EDs. so basically 2 years of FM residency + 1 year of EM fellowship instead of 3 years of EM residency

and if you get burned out from EM work you can always go back to being a hospitalist or outpatient clinic seeing patients of all ages!

your post reminds me of this guy: I wish I had done family medicine

It appears to me lifestyle also plays a big part in OP's decision...

 

[SamtheWise]

I agree with what everyone has said, you should pick up some shifts at the VA ED, or really anywhere that lets you staff without being ABEM certified, just see how you like it. EM is awesome and I wouldn't pick a different specialty, but it's not late term OB, resuscitations and cool undifferentiated patients 95% of the time. Most of the OB you see is hemodynamically stable first trimester vag bleeders and early pregs of unknown location with abdominal pain, most procedures you do are scalp lacs and most undifferentiated patients end up going home after two troponins or a CT a/p still with no known diagnosis. The schedule itself is hard on a family in a different way, my wife gets frustrated with the fact that I get to enjoy weekdays off while she's busy working, but I miss a lot of dinners and weekends.

You have to be ok with the fact that 80% of the time you're a PCP for the underserved, malingering, dysfunctional or all three. 15% of the time you're admitting a terminal cancer patient with chronic pain, some bland uro or pulmonary sepsis, or confused little old lady, all who just need labs and an admit without any cognitive challenge or active resuscitation, and 5% of the time when you actually get a good trauma or critical care case you're absolutely F'ing terrified trying not to kill the trainwreck in front of you.

I think of it as ED doctors are for the most part not really resuscitationists, mini-intensivists, or great diagnosticians, we're problem solvers, we see a patient in front of us and we come up with a disposition rather than a diagnosis. That's the challenge, less so the medicine required to get there. It's easy to order labs, UA and a head CT on a dizzy 90 year old who lives alone and is uninsured, but when all that comes back negative it's hard to come up with what to do with that patient, and that's where the true challenge of EM lies.

However, I'm sure practicing as a hospitalist is not without frustrations, that job seems wretched to be totally honest, I don't blame you for wanting a way out.

 

[deleted497653]

Yeah. Most of the OB is first trimester bleeding. However, last year I had a precipitous delivery. There are cool undifferentiated patients maybe one per shift.

Do pulm ccm or just ccm.

EM is not a lifestyle specialty but is the most flexible in terms of being able to work less. That’s why it’s becoming more and more popular with women.

Don’t do EM. Marginal gain for someone in your position.

 

[Pigg-O-Stat]

If you want to do EM, don't let anyone discourage you. Personally there is no other specialty I would do.

 

[deleted497653]

If you want to do EM, don't let anyone discourage you. Personally there is no other specialty I would do.

You’re not in the same position or situation. OP has already completed one residency. It is logistically harder to do a second residency. Hence, why people are urging / her to consider other options.

 

[Pigg-O-Stat]

I stand by my statement.

 

[deleted497653]

I stand by my statement.

Bruh..

 

[gro2001]

Hi everyone,

I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. I'm planning to apply this coming September but, unfortunately, I don't have any letters of recommendation from Emergency Medicine physicians. Would my application be considered if I don't have LORs from EM physicians? I'm going to apply to most of the 256 EM residency programs to ensure I match.
It seems very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016. I guess, I could work EM shifts at small rural or VA EDs that the locum recruiters keep emailing me about but those seem to be staffed by non-ABEM boarded docs, so I doubt their LORs would be useful.

I would appreciate some advice. Thank you!

Have you considered a second residency in obgyn? They practice, well, ob, and perform life saving procedures. And gyn oncs both prescribe their own chemo AND do the onc surgery. That seems pretty versatile. I don't know a huge amount about the field but I feel someone with a strong medicine background would bring a lot to the table, as the general medical care of pregnant women is a big disparity (they seem to get sub par care with a lot of medical issues because of ob phobia among non ob medical providers).

 

[Lexdiamondz]

Have you considered a second residency in obgyn? They practice, well, ob, and perform life saving procedures. And gyn oncs both prescribe their own chemo AND do the onc surgery. That seems pretty versatile. I don't know a huge amount about the field but I feel someone with a strong medicine background would bring a lot to the table, as the general medical care of pregnant women is a big disparity (they seem to get sub par care with a lot of medical issues because of ob phobia among non ob medical providers).

That’s a pretty miserable prospect - you’re unlikely to get any credit for your IM training and you’ll be working terrible hours with arguably malignant people

 

[GMOnAudi5000]

I think I might be able to help as I have a semi-analogous situation.
I am a GMO in the military, so I started working after my intern year from 2016-2020, that returned to the match this last cycle, after completing a TY in 2015. In regards to the SLOE, I spoke to an APD that said my application would be "DOA" per the above, without an eSLOE. I had emailed CORDEM about it, and they told me to ask the residency specifically. Your best bet is to ask the residencies specifically, as when I made my return to the match, some programs didn't want a SLOE because it wouldn't be helpful, some said they'd consider me without one but that they preferred one, and some said that they wouldn't look at me without one. I ended up providing 1 eSLOE, 1 SLOE, 1 LOR from my current supervisor, and 1 LOR from my old APD (my PD had retired). I ended up with 17 II's at the end of the season (I guess I'll see in 8 days if it worked out).
I ended up getting a SLOE from the institution I did my TY at from my ED month, so if you left in good standing, they should be able to help you out so that you have a complete application. You do not need to be a medical student to get an eSLOE. I also had a friend that was a chief resident at his EM program that offered to let me rotate at his ED in NYC (I just couldn't afford to take the time off from my clinical duties), so if you have colleagues that have gone into similar faculty positions, they may be able to help you. I had GMO colleagues in similar situations that reached back to their medical schools and they were able to draft them an eSLOE. The SLOEs all said great things, and these were referenced in my interviews, even though the SLOE's were all "1 of 1" evaluations.
I would be uncertain about your funding status- I know for myself, any program that extended an offer would be committing to funding 1/2 of my last year, because I ate up a year of ACGME funding from my TY. If you've already completed a residency, I don't know if it would mean that you aren't eligible for funding for a second one. If that's the case, then you may get passed over by the lesser known/lesser funded residencies because they can't afford to have a resident that they need to pay more money for. I had one residency tell me when I asked about their stance on the SLOE that they flat out wouldn't be able to consider me for a spot because of the funding issue from my TY year, and that would have only been 1/2 of a year that the hospital would have had to pay for, let alone a full 3. Your best bet is just to reach out ahead of time and see what the hospitals prefer (I did in fact send out approximately 50-60 emails, to every PD/PC to see what they wanted).

 

[gro2001]

That’s a pretty miserable prospect - you’re unlikely to get any credit for your IM training and you’ll be working terrible hours with arguably malignant people

Maybe. Just basing it off OP's one post that specifically mentioned ob as an interest, so I thought I'd encourage them.

In terms of credit: they aren't going to get a lot of credit for their IM training in EM either. That is, assuming you mean credit in months towards graduation requirements from residency. If you mean credit in terms of being recognized as a valuable member of the specialty, I still think an obgyn with a strong medicine background is going to be appreciated.

 

[IM.MD]

Thank you everyone for the great replies. I'll try to do some EM work and get an LOR from an ABEM doc and possibly apply very broadly to EM residencies in September. Meanwhile, I'll continue to consider CCM. Perhaps, I'll apply to both Be safe in the midst of the COVID-19 pandemic!

 

[Turfandbuff]

Hi IM.MD, I am applying for EM as well like you.
Background: IMG who failed matching to EM then did IM. Now, I'm done waiver now.
Hope with no visa issue & LoR/s from where I did EM research fellowship will help.

I read from the CORD EM FAQ page, we as hospitalists are not qualified for SLOE. However, they recommended 2-4 letter of evaluation which I do not know whether it is the same with LoR. I emailed them and will keep you update.
SLOE FAQ page:
cordem.org/resources/residency-management/sloe/esloe/esloefaq/?pageID=3747

Good luck!

 

[Airborne Flt Doc]

Hi everyone,

I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. I'm planning to apply this coming September but, unfortunately, I don't have any letters of recommendation from Emergency Medicine physicians. Would my application be considered if I don't have LORs from EM physicians? I'm going to apply to most of the 256 EM residency programs to ensure I match.
It seems very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016. I guess, I could work EM shifts at small rural or VA EDs that the locum recruiters keep emailing me about but those seem to be staffed by non-ABEM boarded docs, so I doubt their LORs would be useful.

I would appreciate some advice. Thank you!

You don’t need to do another residency. You can read the recommendations on the forum “Can I practice em after im residency.”

 

[Splenda88]

90%+ of the stuff that come to the ED can be treated by a PCP. No need to do an EM residency when you might find rural/suburb ED that will hire you. The VA that my residency is affiliated with is in a major city and most of the docs in the ED are IM docs.

 

[Lexdiamondz]

90%+ of the stuff that come to the ED can be treated by a PCP. No need to do an EM residency when you might find rural/suburb ED that will hire you. The VA that my residency is affiliated with is in a major city and most of the docs in the ED are IM docs.

Funny, my residency also has a VA ED that is primarily staffed by IM attendings. We can't work there due to ACGME rules. Guess who complains about that the most? The IM residents themselves. Apparently having an ED staffed by a bunch of non-EM trained docs leads to ****ty admissions, alot of punting, bad workups and marginal at best care.

Did you learn peds in your IM residency? How about GYN? How about Ortho? Optho? How confident are you in your airway skills? Conscious sedation? Trauma?

I got a transfer last week who was a walk in trauma that stumbled into a community ED with a GSW to the face. Community IM doc misses tube x 4 and leaves it a bloody mess - a gen surg guy had to come in and cric the guy. That's the job you're signing up for.

To OP - Yeah you can get a job, but a hospitalist 3 years out is not going to have the skills to safely staff an ER and will have a steep learning curve. Plus the job market being down overall means you'll be much less competitive for the openings that do exist.

 

[Splenda88]

Funny, my residency also has a VA ED that is primarily staffed by IM attendings. We can't work there due to ACGME rules. Guess who complains about that the most? The IM residents themselves. Apparently having an ED staffed by a bunch of non-EM trained docs leads to ****ty admissions, alot of punting, bad workups and marginal at best care.

Did you learn peds in your IM residency? How about GYN? How about Ortho? Optho? How confident are you in your airway skills? Conscious sedation? Trauma?

I got a transfer last week who was a walk in trauma that stumbled into a community ED with a GSW to the face. Community IM doc misses tube x 4 and leaves it a bloody mess - a gen surg guy had to come in and cric the guy. That's the job you're signing up for.

To OP - Yeah you can get a job, but a hospitalist 3 years out is not going to have the skills to safely staff an ER and will have a steep learning curve. Plus the job market being down overall means you'll be much less competitive for the openings that do exist.

Interesting... We (IM docs) complain how terrible ED physician workups are at our main hospital... I try to defend EM docs all the time. Most physicians do not seem to understand the role of ED docs.

 

[turkeyjerky]

I semi-agree with this statement amidst an otherwise great post. We really are problem solvers as we have to get a patient from the ED door to a disposition within a short time frame with limited information. It's often easy to admit a critically ill patient to the ICU or send a stubbed toe home. The 90% of the middle takes finesse and a true MacGyver. However, I consider myself a phenomenal resusciationist. I also consider many of my EP brethren in the same boat. Don't sell us short in this regard. Intensivists, anesthesiologists and surgeons all have skills that I don't. If a patient is cashing and circling the drain though, I want to be right there at the head of the bed with the airway, in the groin with the lines and using my brain in light speed to know how to intervene and just as importantly how not to.

Maybe true (I have my doubts). However, you also have to figure out which 90% are the 90%. You can't miss the 10%. Everyone is a ticking time bomb waiting to die. Almost everyone isn't going to blow up right now, but some subtly will with their silent timers. You have to try to find them. Our training as EPs helps us sniff out those seemingly well individuals that have serious pathology. Once you find them you also have to know what to do with them. The answer isn't to call anesthesia, surgery, cardiology or anyone else on everyone or immediately on those that you really do need to. It's to resuscitate them and involve specialists at the right times and for the right reasons.

I couldn't agree with you more......But I think we have to admit that there are an (alarmingly large) number of our colleagues who believe (or at least behave as if) resuscitating a patient means calling a CC consult and prioritizing the dispo (and PG score) of the stubbed toe. More importantly, many stakeholders prefer this.

 

[Airborne Flt Doc]

Funny, my residency also has a VA ED that is primarily staffed by IM attendings. We can't work there due to ACGME rules. Guess who complains about that the most? The IM residents themselves. Apparently having an ED staffed by a bunch of non-EM trained docs leads to ****ty admissions, alot of punting, bad workups and marginal at best care.

Did you learn peds in your IM residency? How about GYN? How about Ortho? Optho? How confident are you in your airway skills? Conscious sedation? Trauma?

I got a transfer last week who was a walk in trauma that stumbled into a community ED with a GSW to the face. Community IM doc misses tube x 4 and leaves it a bloody mess - a gen surg guy had to come in and cric the guy. That's the job you're signing up for.

To OP - Yeah you can get a job, but a hospitalist 3 years out is not going to have the skills to safely staff an ER and will have a steep learning curve. Plus the job market being down overall means you'll be much less competitive for the openings that do exist.

Why didn’t you cric? By the way, how many times have you had to cric a patient ? Statistics and experts say your case log says 0 of these procedures over the last 2 years. Mayby you’ll get 1 by 5 years practicing

The Difficult Airway has its own algorithm & everyone should be practicing yearly since it is a rare procedure in most community EDs. Just like pericardiocentesis, rare.

The Difficult Airway Course /Skills Labs/Cadaver Sessions are offered yearly for this very reason.

Peds- Stabilize & transfer to the nearest Children’s Hospital.

OBGYN- stabilize & transfer to nearest L&D.

Trauma- stabilize & transfer nearest Trauma Ctr.

(EM didn’t learn everything about kids in 4-6 weeks rotations of residency, or 1 month OB/GYN , 1 month Ortho or 2 week Optho rotation).

Optho.....No one but academic sites seem to have Optho on call, so you’ll transfer for those select few cases too.

A lot of ABEM docs want all the specialist at there fingertips , so they stay close to the big cities ( that pay much much less btw ) & academic or trauma centers. They do not like being anywhere they have to transfer a lot, or have a lack of specialist, so plenty of jobs for IM/FP, etc to fill.

 

[Lexdiamondz]

Why didn’t you cric? By the way, how many times have you had to cric a patient ? Statistics and experts say your case log says 0 of these procedures over the last 2 years. Mayby you’ll get 1 by 5 years practicing

The Difficult Airway has its own algorithm & everyone should be practicing yearly since it is a rare procedure in most community EDs. Just like pericardiocentesis, rare.

The Difficult Airway Course /Skills Labs/Cadaver Sessions are offered yearly for this very reason.

I'm over 200 airways in and have never had to cric a pt before. They happen, and probably will happen to me at some point in my career, but there are enough airway adjuncts that crics are justifiably rare in the hands of an appropriately trained EP. As mentioned previously, a cric should be for a patient who has some anatomical reason to be unable to be intubated/ventilated orotracheally

Peds- Stabilize & transfer to the nearest Children’s Hospital.

OBGYN- stabilize & transfer to nearest L&D.

Trauma- stabilize & transfer nearest Trauma Ctr.

(EM didn’t learn everything about kids in 4-6 weeks rotations of residency, or 1 month OB/GYN , 1 month Ortho or 2 week Optho rotation).

Optho.....No one but academic sites seem to have Optho on call, so you’ll transfer for those select few cases too.

A lot of ABEM docs want all the specialist at there fingertips , so they stay close to the big cities ( that pay much much less btw ) & academic or trauma centers. They do not like being anywhere they have to transfer a lot, or have a lack of specialist, so plenty of jobs for IM/FP, etc to fill.

You assume the average non-ABEM has any idea how to really stabilise and transfer much of what they see.