Why hustle hard for an EM residency when FM docs "with EM experience" qualify for the same jobs?

[TurboDO]

Hey guys,

I know I know, the title is a little provocative. But I am genuinely curious to hear your thoughts on the matter. I was reading some EM job boards today where seemingly every job I came across (I mostly searched TX and WI) was available to FP and IM docs with some "EM experience" and ALS/ATLS certs. Even those good ol' $500k/year ones in west TX!

Guess I am just trying to make sense of this. We all worked hard to qualify for an EM residency spot presumably so we could be trained to perform a job that other docs can't (or can't do as well). To think that I could have instead just slept through medical school and into an FM residency, with access to the same job opportunities after, is pretty frustrating (I am not trying to knock FM but the fact remains it is a fallback for many).

Can anyone explain? Are my optics off on this? Flame suit on and no I am not a troll, I am an MS4 who matched EM this cycle. Thanks in advance

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[DO2016EM]

Hey guys,

I know I know, the title is a little provocative. But I am genuinely curious to hear your thoughts on the matter. I was reading some EM job boards today where seemingly every job I came across (I mostly searched TX and WI) was available to FP and IM docs with some "EM experience" and ALS/ATLS certs. Even those good ol' $500k/year ones in west TX!

Guess I am just trying to make sense of this. We all worked hard to qualify for an EM residency spot presumably so we could be trained to perform a job that other docs can't (or can't do as well). To think that I could have instead just slept through medical school and into an FM residency, with access to the same job opportunities after, is pretty frustrating (I am not trying to knock FM but the fact remains it is a fallback for many).

Can anyone explain? Are my optics off on this? Flame suit on and no I am not a troll, I am an MS4 who matched EM this cycle. Thanks in advance

I want to live near civilization when I graduate residency. Most of those jobs are in rural areas, no?

 

[hello1234!]

So fm docs sleep through med school?
Not sure why u are frustrated at FM docs income level. Your argument should be based on level of training to be a competent ER doc.

 

[Fox800]

There's a reason those jobs pay "500k". They're in goat ***, Wisconsin and they suck. Far away from anything, poor ancillary support, poor consultant coverage, blah blah. EM is a buyer's market. There aren't enough BCEM physicians to go around, and hospitals have to staff their ERs with someone.

Those FM docs will never be able to work at big-name places, or academic places, or hospitals in decently nice parts of town. They'll be stuck out in the sticks.

As an M4 that matched into EM, you should feel good about this. It means you're in an enviable bargaining position when it comes to job-hunting.

 

[gman33]

The reason is that you want to be trained to do your job.

Fm residency won't do that.

 

[dadaddadaBATMAN]

Hey guys,

I know I know, the title is a little provocative. But I am genuinely curious to hear your thoughts on the matter. I was reading some EM job boards today where seemingly every job I came across (I mostly searched TX and WI) was available to FP and IM docs with some "EM experience" and ALS/ATLS certs. Even those good ol' $500k/year ones in west TX!

Guess I am just trying to make sense of this. We all worked hard to qualify for an EM residency spot presumably so we could be trained to perform a job that other docs can't (or can't do as well). To think that I could have instead just slept through medical school and into an FM residency, with access to the same job opportunities after, is pretty frustrating (I am not trying to knock FM but the fact remains it is a fallback for many).

Can anyone explain? Are my optics off on this? Flame suit on and no I am not a troll, I am an MS4 who matched EM this cycle. Thanks in advance

Couple of things.
1.) I want to be well trained for the procedures and medical decision making I will make day to day (fm will do this for fm, not em).
2.) salary isn't everything about a job, and there is often a reason for the high pay (lack of benefits, **** location and working conditions)
3.) fm also has derm fellowships and people doing colonoscopies. I don't see derm/gi people sweating bullets
4.) I think your question is sort of like asking "why work hard in undergrad when there are these great carribean schools that teach the same things"

 

[WilcoWorld]

The FP-trained docs do not qualify for the same jobs. These are jobs that BCEPs aren't taking.

 

[littlejuan]

FM/IM docs can't get the job I have lined up. It's a great group, pays well, and in a desirable location.

 

[TurboDO]

So fm docs sleep through med school?
Not sure why u are frustrated at FM docs income level. Your argument should be based on level of training to be a competent ER doc.

No, that's not exactly what I said. There are plenty of folks every year who want to go into FM despite being qualified for other specialities. But there are also many who don't take med school seriously, failed/have low board scores, went to a caribbean school, etc and weren't able to match into anything else. You don't need me to tell you this, it's just the reality of it - sorry if that offends you.

There's a reason those jobs pay "500k". They're in goat ***, Wisconsin and they suck. Far away from anything, poor ancillary support, poor consultant coverage, blah blah. EM is a buyer's market. There aren't enough BCEM physicians to go around, and hospitals have to staff their ERs with someone.

Those FM docs will never be able to work at big-name places, or academic places, or hospitals in decently nice parts of town. They'll be stuck out in the sticks.

As an M4 that matched into EM, you should feel good about this. It means you're in an enviable bargaining position when it comes to job-hunting.

The FP-trained docs do not qualify for the same jobs. These are jobs that BCEPs aren't taking.

The FP-trained docs do not qualify for the same jobs. These are jobs that BCEPs aren't taking.

FM/IM docs can't get the job I have lined up. It's a great group, pays well, and in a desirable location.

Thanks for the replies. I definitely feel good about matching EM because of course I intrinsically want to be trained to do my job as well as possible. But discussing that was not the goal of my post, I should have been more clear. I was more interested in sussing out and understanding the superficial "economics" of the issue. And based on your guys' responses, it seems the major difference lay in the quality of the job opportunities and their locations, which is significant. Thank you for clarifying this for me. It will probably take me graduating from residency in 3 years to truly appreciate the magnitude of these differences, but until then I will definitely take your words for it. Thanks again.

 

[TurboDO]

Couple of things.
1.) I want to be well trained for the procedures and medical decision making I will make day to day (fm will do this for fm, not em).
2.) salary isn't everything about a job, and there is often a reason for the high pay (lack of benefits, **** location and working conditions)
3.) fm also has derm fellowships and people doing colonoscopies. I don't see derm/gi people sweating bullets
4.) I think your question is sort of like asking "why work hard in undergrad when there are these great carribean schools that teach the same things"

Good point re: colonoscopies and derm, hadn't thought about it that way. Guess the dermatologists'/gastroenterologists' credentials must just attract the lions share of patients seeking those treatments, leaving not many for the FPs seeking to do the same.

re: 4), you may be right but caribbean schools more and more are seeing a serious barrier to entry into residency for their graduates, where as I can't comment on the barriers to entry on an FP doc seeking to do colonoscopies or work as an EM physicians. I would imagine they're lower though, tbh.

 

[DeadCactus]

Good point, you should go for it. Don't even try for a good FM program, just find one looking for a warm body and call it a day.

 

[hello1234!]

I know I know, the title is a little provocative. ... ... To think that I could have instead just slept through medical school and into an FM residency, with access to the same job opportunities after, is pretty frustrating (I am not trying to knock FM but the fact remains it is a fallback for many). .. ... I am not a troll

generally, when someone says that they are not trying to knock something down, that is exactly what they are doing... ...

 

[e30ftw]

The thread title is false and misleading.

FM trained physicians do not qualify for the same jobs as ABEM physicians.

The majority of community EDs in reasonably desirable urban/suburban locations are staffed by ABEM physicians. This does not include small hospitals in isolated counties in between metro areas, which are commonly staffed by IM/FM/GSx w ED experience, mainly due to lack of ABEM providers and low pay. Occasionally these hospitals are desperate and offer a non-ABEM provider increased comp but that's no way to routinely make a living.

Very occasionally I pick up shifts at a ~8k/yr 6 bed ED 1 hour away from my main job. They are staffed almost exclusively with IM/FM docs who are grateful for the chance to make $120/hr as it's more pay for less work than seeing 30 pts/day in clinic. My rate is around twice that. This is through a CMG by the way.. not an uncommon arrangement to have two separate rates, one for ABEM docs and one for everyone else.

Regardless, anyone reading this thread, FM docs with EM experience do not qualify for the same jobs as ABEM physicians. In EM, demand >>> supply at the moment and being board certified, thanks to the hard work of the founders of our field, is a definite advantage and currently, requirement, for most desirable jobs in Emergency Medicine.

 

[The White Coat Investor]

Absolutely. Thread title is false. You don't qualify for the same job.

The clowns on this forum refer to my job as a "unicorn job" and a "Shangri-la." Guess what? There is approximately a 0% chance of an FP trained doc ever being hired here. The last one was in 1986.

 

[Apollyon]

Absolutely. Thread title is false. You don't qualify for the same job.

The clowns on this forum refer to my job as a "unicorn job" and a "Shangri-la." Guess what? There is approximately a 0% chance of an FP trained doc ever being hired here. The last one was in 1986.

Hell, I'm an FMG, and I am rather quite sure your group wouldn't hire me, either!

 

[Birdstrike]

Hey guys,

I know I know, the title is a little provocative. But I am genuinely curious to hear your thoughts on the matter. I was reading some EM job boards today where seemingly every job I came across (I mostly searched TX and WI) was available to FP and IM docs with some "EM experience" and ALS/ATLS certs. Even those good ol' $500k/year ones in west TX!

Guess I am just trying to make sense of this. We all worked hard to qualify for an EM residency spot presumably so we could be trained to perform a job that other docs can't (or can't do as well). To think that I could have instead just slept through medical school and into an FM residency, with access to the same job opportunities after, is pretty frustrating (I am not trying to knock FM but the fact remains it is a fallback for many).

Can anyone explain? Are my optics off on this? Flame suit on and no I am not a troll, I am an MS4 who matched EM this cycle. Thanks in advance

Your title is false. "FM with EM experience" doctors are much less competitive in the EM job market, at large.


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[emergentmd]

Christie Brinkley qualifies as a supermodel.

Rosanne Barr qualifies as a supermodel too in the Back country of Antarctica.

Would you want to be Rosanne Barr or put in the effort/exercise to be Brinkley?

Hmmmmm

I think I will stick with being EM boarded

 

[WilcoWorld]

Absolutely. Thread title is false. You don't qualify for the same job.

The clowns on this forum refer to my job as a "unicorn job" and a "Shangri-la." Guess what? There is approximately a 0% chance of an FP trained doc ever being hired here. The last one was in 1986.

Clowns, huh? I meant "Shangri-la" to be a complimentary reference meaning "highly desirable but tough to find". Seems like I struck a nerve. If so, please understand that no offense was intended.

 

[The White Coat Investor]

Clowns, huh? I meant "Shangri-la" to be a complimentary reference meaning "highly desirable but tough to find". Seems like I struck a nerve. If so, please understand that no offense was intended.

Oh, I wasn't offended by any means and took it as a compliment. Nor did I mean any offense with the term clowns. Funny how hard it is to convey tone on the internet isn't it.

 

[MSmentor018]

the op brings up an interesting point. you can do FP, work in the sticks for a few then take the apbs boards. viola' now you're EM boarded. although there are some jobs that want abem only

 

[bravotwozero]

MOST of the good jobs want ABEM only. Don't know too many places that recognize or care for abps


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[deleted109597]

the op brings up an interesting point. you can do FP, work in the sticks for a few then take the apbs boards. viola' now you're EM boarded. although there are some jobs that want abem only

Very few states allow ABPS boarded people to claim board certification. Texas did for about 8 weeks until there was effectively a mutiny.

 

[SID8298]

MG

WHat is a CMG?

 

[deleted859535]

+1 to those pointing out that this thread was inaccurate starting with the very title.

My (small democratic) group also will not hire anything but BC/BE EM anymore, save for locums at one of our small, critical access, low acuity, low volume places -- and even that has gone away.

 

[Mt Kilimanjaro]

Hey guys,

I know I know, the title is a little provocative. But I am genuinely curious to hear your thoughts on the matter. I was reading some EM job boards today where seemingly every job I came across (I mostly searched TX and WI) was available to FP and IM docs with some "EM experience" and ALS/ATLS certs. Even those good ol' $500k/year ones in west TX!

Guess I am just trying to make sense of this. We all worked hard to qualify for an EM residency spot presumably so we could be trained to perform a job that other docs can't (or can't do as well). To think that I could have instead just slept through medical school and into an FM residency, with access to the same job opportunities after, is pretty frustrating (I am not trying to knock FM but the fact remains it is a fallback for many).

Can anyone explain? Are my optics off on this? Flame suit on and no I am not a troll, I am an MS4 who matched EM this cycle. Thanks in advance

Posts like this always baffle me in the context of vast amounts of mid levels in almost every ED and many (most?) EM residents moonlighting independently after R1 or R2.

Would be curious to read studies comparing ED outcomes for FP/IM vs EM vs mid level if anyone has links.

 

[emergentmd]

EM>>>>> FM with ER experience >>>>> FM without experience.

When there is a BIG shortage of EM docs, some difficult to work bones will be given to FM with ER experience. FM without would just be stuck in Sleepy ERs in the middle of nowhere.

When EM gets saturated, and it will/has, those bones will be gone and FM with ER experience will be relegated to lower paying Sleepy rural areas. FM without would be without even scraps

There my be reality for burn out, but for the past 20 Yrs working in the ED, there is very little retirement. Most EM docs I know work 2-30+ yrs and early retirement is very rare due to burn out. There are just too many options to do part time EM/UC/FSER or just working half time and still making 200K.

SO take your risk of going FM with ER experience. You may turn around in 3 yrs and left with no jobs even in the most undesirable places.

 

[GonnaBeADoc2222]

Are we seriously doing this again?

 

[VA Hopeful Dr]

Are we seriously doing this again?

You're just mad because with a 1 year unaccredited fellowship I can do your job as well as you. So there!

[/sarcasm]

 

[Groove]

 

[Redrox]

Posts like this always baffle me in the context of vast amounts of mid levels in almost every ED and many (most?) EM residents moonlighting independently after R1 or R2.

Would be curious to read studies comparing ED outcomes for FP/IM vs EM vs mid level if anyone has links.

I'll toss some 2 cents here, sure why not.

I work with midlevels in my main site and a couple days a month I'm out in the boonies where some family docs work too.

Think the midlevels are better overall clinicians. They've been working years side by side with us docs and we're constantly giving them feedback, pearls and education. Family docs at my rural site are solo-practioners with no overlap with docs so they aren't getting any of that so I hope they're reading a bunch.

Our midlevels can't intubate or central line though, so thems lacking there, though I've heard some serious goat rodeo stories of our FM docs trying at my rural site.

All things considered, though, the FM docs out here do more or less fine work. They fill a need and serve the community. Good guys and I'm happy to have them around.