Will this allow me to work in an ER?

[kedhegard]

I'm planning on going into family practice. After my residency, I'm thinking about doing an emergency medicine fellowship, of which there are six in the nation. Here is an example: http://www.aafp.org/fellowships/240.html

Is this sufficient to work part time in an ER as I work on building my practice?

Thanks guys.

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[WakeMedHeel]

I'm planning on going into family practice. After my residency, I'm thinking about doing an emergency medicine fellowship, of which there are six in the nation. Here is an example: http://www.aafp.org/fellowships/240.html

Is this sufficient to work part time in an ER as I work on building my practice?

Thanks guys.

Only if the fellowship is at one of the top 10 ER programs...

 

[DrMom]

I'm planning on going into family practice. After my residency, I'm thinking about doing an emergency medicine fellowship, of which there are six in the nation. Here is an example: http://www.aafp.org/fellowships/240.html

Is this sufficient to work part time in an ER as I work on building my practice?

Thanks guys.

I asked around about these kinds of programs a while back. The consensus was that this doesn't make you board eligible in EM. While smaller hospitals will currently hire non-EM docs to work the ED, malpractice insurance companies are making this more difficult by being hesitant to insure non-EM-board-eligible docs.

I'm sure someone with more info can clarify more.

 

[kedhegard]

While smaller hospitals will currently hire non-EM docs to work the ED,

That's more or less my plan, to work in a small hospital for the first few years post-residency.

 

[DrMom]

The unknown component is this: how long will it be until the malpractice ins companies make it too expensive to insure non-EM-boarded docs or simply refuse to do so at all?


again, there are people out there who are more informed than I am who'll hopefully chime in

 

[Sessamoid]

It also depends on where this prospective small-hospital is located. If it's a small hospital in certain areas, you can forget it. LA? SF? Forget it. I've job hunted there, and you have to be a residency grad now, regardless of how small the hospital is. Even some smaller cities/towns can be locked down depending on how desirable the location/job situation is.

 

[margaritaboy]

I'm planning on going into family practice. After my residency, I'm thinking about doing an emergency medicine fellowship, of which there are six in the nation. Here is an example: http://www.aafp.org/fellowships/240.html

Is this sufficient to work part time in an ER as I work on building my practice?

Thanks guys.

Simply completing your FP residency should be sufficient to work in an ER, though as some have pointed out it may not be where you want and you wouldn't be board eligible for EM with or without the fellowship. I've known some FPs that have worked in ERs straight out of residency, usually in smaller towns or in the 'fast tracks' in more urban communities. It's really not a bad deal, especially if you are looking for work as you get your clinic going.

 

[ntmed]

I asked around about these kinds of programs a while back. The consensus was that this doesn't make you board eligible in EM.

It's my understanding that you can be board certified in the state of Florida after one year of fellowship training and one year of ER employment.

 

[DrMom]

It's my understanding that you can be board certified in the state of Florida after one year of fellowship training and one year of ER employment.

Is this a board certification that is actually recognized by ABEM? I can get a board cert in OK by doing a 1 year EM fellowship after a FM residency, but I won't be recognized by any EM organization as being EM board certified.

 

[Sessamoid]

Nope. BCEM is a sham, and it isn't recognized by the American Board of Emergency Medicine, nor is it recognized by the American Board of Medical Specialties. The ABMS is the board that certifies every other legitimate specialty in our country.

More and more glad I got out of Florida before it goes completely to hell.

 

[ntmed]

Nope. BCEM is a sham, and it isn't recognized by the American Board of Emergency Medicine, nor is it recognized by the American Board of Medical Specialties. The ABMS is the board that certifies every other legitimate specialty in our country.

I don't know if BCEM training is a reasonable way to go. But here are a couple articles on each side of the issue.

EMRA article against BCEM:
http://www.emra.org/index.cfm?FuseAction=Page&PageID=1001639

Section 8c explains how BCEM can lead to certification within the ABPS:
http://www.abpsga.org/certification/emergency/eligibility.html

For what it's worth, I see a parallel between those who don't want EM docs to get certified in CCM, and those who don't want primary care docs to get certified in EM through fellowship training. Instead of these turf battles, wouldn't it be better to come up with reasonable fellowship paths for both groups and then live-and-let-live?

 

[neutropeniaboy]

Nope. BCEM is a sham, and it isn't recognized by the American Board of Emergency Medicine, nor is it recognized by the American Board of Medical Specialties. The ABMS is the board that certifies every other legitimate specialty in our country.

More and more glad I got out of Florida before it goes completely to hell.

Hmmm. A sham? That's a pretty strong claim.

Besides, someone who completes a residency in, say, surgery and then works for 5 years in an ER then sits for this "sham" board to become certified just may well have more experience and knowledge than someone, say, taking their "non-sham" boards 3 years after medical school...But, what the hey. You're both "certified."

 

[12R34Y]

Good point neutrapenia boy........I guess if an EM doc wanted to start working with an ENT guy doing some clinic and OR time then after a few years he's probably at least if not more knowledgable than your average ENT person out of residency (afterall surgery is just some on the job training that with repetition the EM guy will probably master most basic ENT surgeries)

excellent reasoning.

later

 

[margaritaboy]

Good point neutrapenia boy........I guess if an EM doc wanted to start working with an ENT guy doing some clinic and OR time then after a few years he's probably at least if not more knowledgable than your average ENT person out of residency (afterall surgery is just some on the job training that with repetition the EM guy will probably master most basic ENT surgeries)

excellent reasoning.

later

Interesting. Does that mean I should take my sinus surgery to the ER, and show up in cardiac arrest at the ENT clinic?

 

[emdoc21]

Nope. BCEM is a sham, and it isn't recognized by the American Board of Emergency Medicine, nor is it recognized by the American Board of Medical Specialties. The ABMS is the board that certifies every other legitimate specialty in our country.

More and more glad I got out of Florida before it goes completely to hell.

Here's some more info on BCEM and what happened recently in Florida:

http://www.aaem.org/aaemres/issues/florida.php

http://www.aaem.org/aaemres/forums/viewtopic.php?t=11

http://www.aaem.org/floridaboard/

Take care,
Mark Reiter
UNC EM

 

[Freeeedom!]

Much of the point is that people are realizing where the money and lifestyle is...EM and they will do anything to achieve such a life, even "back door" routes to specialization.

 

[12R34Y]

yeah, I think cardiac arrests in the ENT office would go over GREAT. (cringing)

later

 

[neutropeniaboy]

Not even closely paralleled, skippies.

Answer this: Of all the emergency departments in all the hospitals in this country, how many of these "emergency physicians" actually graduated from an accredited emergency medicine residency program and how many of them are board certified by the ABEM?

(I guess the rest aren't qualified...)

 

[neutropeniaboy]

yeah, I think cardiac arrests in the ENT office would go over GREAT. (cringing)

later

Is that what that red cart is for?

(And thank GOD you guys do all the TPA, catheterizations, stenting, and bypasses -- not me -- that really help them turn the corner.)

 

[roja]

To the OP: I think that if you want to work in a small, noncompetitive ED, you probably won’t have much of a problem. A year fellowship, even if its not ABEM certification, makes you a more attractive candidate and might even lower your malpractice (not sure about that but it seems to make sense).

Despite the occasional trollish post that drops into the EM forum, the ABEM certification is not a pissing match. An ED patients morbidity and mortality is significantly higher when non-EMP’s are staffing an ED. (this is why malpractice is higher…) A years fellowship would give you some very valuable time in the ED. It would, hopefully, give you some experience with RSI intubations, medical and trauma resuscitations, and the general tenets of EM.


Neutropenia: Condescending posts (particularly when inaccurate) do not add any extra validation to your point. In fact, it is a VERY accurate comparison. While a surgeon (assuming trained at a high volume trauma center) will be adequately trained to manage a trauma patient, they are not going to be qualified to manage the vast majority of the other patients in the ED. They are not qualified to manage a sexual assault, a pediatric seizure, a pregnant patient with vaginal bleeding, a dislocated shoulder, RSI etc etc etc. Oddly enough, because they are trained to be a surgeon. Just as I am not trained to perform an appendectomy. And just like I don’t want to perform an appendectomy, the vast majority of surgeons don’t want to manage all the other ‘nonsurgical’ issues in the ED.

And yes, many MD’s working in small ED’s are not qualified to be working there. This is just one of MANY stories: My stepmother is a CRNA in a smaller town. She has to take home call (about 20 minutes away). The ED is staffed by non-EM trained MD’s. She has been called in to intubate a patient and to gain IV access because the MD working in the ED was not trained in RSI or in placing central lines.

Many older, non residency trained, EMP’s are board certified by ABEM because they were able to grandfather in. However, this is a track that is now closed. With very good reason.


So, just as I didn’t want a non-ENT trained MD to put in my daughters tubes, I wouldn’t want a non-EM trained MD to manage my family member in an emergency room.

 

[12R34Y]

Excellent post roja!

I just couldn't resist posting such a ridiculous comparison to prove a point. However, your post is much more elegant and well reasoned.

later

 

[EMDrMoe]

Very well said, Roja. Very well said.

 

[docB]

Not even closely paralleled, skippies.

Answer this: Of all the emergency departments in all the hospitals in this country, how many of these "emergency physicians" actually graduated from an accredited emergency medicine residency program and how many of them are board certified by the ABEM?

(I guess the rest aren't qualified...)

Last I heard there were about 30,000 "EPs" and about 20,000 ABEM certed EPs. I obtained these figures with and anoscope and a pair of forceps so if some one with more time, dedication and initiative would like to research more current numbers have at.

 

[ERMudPhud]

Just like any argument there is the insolent, arrogant, "insufferable" side and the evidence based side...

J Emerg Med. 2000 Aug;19(2):99-105.

*
Malpractice occurrence in emergency medicine: does residency training make a difference?

Branney SW, Pons PT, Markovchick VJ, Thomasson GO.

Denver Health Residency in Emergency Medicine, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.

We evaluated the effects of Emergency Medicine (EM) residency training, EM board certification, and physician experience on the occurrence of malpractice claims and indemnity payments. This was a retrospective review of closed malpractice claims from a single insurer. Outcome measures included the occurrence of claims resulting in indemnity, indemnity amounts, and defense costs. Differences in the outcome measures were compared based on: EM residency training, EM board certification, EM residency training versus other residency training, and physician experience using both univariate and multivariate analyses. There were 428 closed EM claims with indemnity paid in 81 (18.9%). Indemnity was paid in 22. 4% of closed claims against non-EM residency-trained physicians, and in only 13.3% against EM residency-trained physicians (p = 0.04). The total indemnity was $6,214,475. Non-EM trained physicians accounted for $4,440,951 (71.5%), EM residency-trained physicians accounted for $1,773,524 (28.5%). The average indemnity was $76,721 and the average defense cost was $17,775. There were no significant differences in the mean indemnity paid per closed claim or the mean cost to defend a closed claim when comparing EM-trained and non-EM residency-trained physicians. The total cost (indemnity + defense costs) per physician-year of malpractice coverage was $4,905 for non-EM residency-trained physicians and $2,212 for EM residency-trained physicians. EM residency-trained physicians account for significantly less malpractice indemnity than non-EM residency-trained physicians. This difference is not due to differences in the average indemnity but is due to significantly fewer closed claims against EM residency-trained physicians with indemnity paid. This results in a cost per physician-year of malpractice coverage for non-EM residency-trained physicians that is over twice that of EM residency-trained physicians.

PMID: 10903454 [PubMed - indexed for MEDLINE]

 

[roja]

Just like any argument there is the insolent, arrogant, "insufferable" side and the evidence based side...

J Emerg Med. 2000 Aug;19(2):99-105.

*
Malpractice occurrence in emergency medicine: does residency training make a difference?

Branney SW, Pons PT, Markovchick VJ, Thomasson GO.

Denver Health Residency in Emergency Medicine, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.

We evaluated the effects of Emergency Medicine (EM) residency training, EM board certification, and physician experience on the occurrence of malpractice claims and indemnity payments. This was a retrospective review of closed malpractice claims from a single insurer. Outcome measures included the occurrence of claims resulting in indemnity, indemnity amounts, and defense costs. Differences in the outcome measures were compared based on: EM residency training, EM board certification, EM residency training versus other residency training, and physician experience using both univariate and multivariate analyses. There were 428 closed EM claims with indemnity paid in 81 (18.9%). Indemnity was paid in 22. 4% of closed claims against non-EM residency-trained physicians, and in only 13.3% against EM residency-trained physicians (p = 0.04). The total indemnity was $6,214,475. Non-EM trained physicians accounted for $4,440,951 (71.5%), EM residency-trained physicians accounted for $1,773,524 (28.5%). The average indemnity was $76,721 and the average defense cost was $17,775. There were no significant differences in the mean indemnity paid per closed claim or the mean cost to defend a closed claim when comparing EM-trained and non-EM residency-trained physicians. The total cost (indemnity + defense costs) per physician-year of malpractice coverage was $4,905 for non-EM residency-trained physicians and $2,212 for EM residency-trained physicians. EM residency-trained physicians account for significantly less malpractice indemnity than non-EM residency-trained physicians. This difference is not due to differences in the average indemnity but is due to significantly fewer closed claims against EM residency-trained physicians with indemnity paid. This results in a cost per physician-year of malpractice coverage for non-EM residency-trained physicians that is over twice that of EM residency-trained physicians.

PMID: 10903454 [PubMed - indexed for MEDLINE]

Thanks mud.



And thanks for the appreciation, guys.

 

[leviathan]

To the OP: I think that if you want to work in a small, noncompetitive ED, you probably won’t have much of a problem. A year fellowship, even if its not ABEM certification, makes you a more attractive candidate and might even lower your malpractice (not sure about that but it seems to make sense).

Despite the occasional trollish post that drops into the EM forum, the ABEM certification is not a pissing match. An ED patients morbidity and mortality is significantly higher when non-EMP’s are staffing an ED. (this is why malpractice is higher…) A years fellowship would give you some very valuable time in the ED. It would, hopefully, give you some experience with RSI intubations, medical and trauma resuscitations, and the general tenets of EM.


Neutropenia: Condescending posts (particularly when inaccurate) do not add any extra validation to your point. In fact, it is a VERY accurate comparison. While a surgeon (assuming trained at a high volume trauma center) will be adequately trained to manage a trauma patient, they are not going to be qualified to manage the vast majority of the other patients in the ED. They are not qualified to manage a sexual assault, a pediatric seizure, a pregnant patient with vaginal bleeding, a dislocated shoulder, RSI etc etc etc. Oddly enough, because they are trained to be a surgeon. Just as I am not trained to perform an appendectomy. And just like I don’t want to perform an appendectomy, the vast majority of surgeons don’t want to manage all the other ‘nonsurgical’ issues in the ED.

And yes, many MD’s working in small ED’s are not qualified to be working there. This is just one of MANY stories: My stepmother is a CRNA in a smaller town. She has to take home call (about 20 minutes away). The ED is staffed by non-EM trained MD’s. She has been called in to intubate a patient and to gain IV access because the MD working in the ED was not trained in RSI or in placing central lines.

Many older, non residency trained, EMP’s are board certified by ABEM because they were able to grandfather in. However, this is a track that is now closed. With very good reason.


So, just as I didn’t want a non-ENT trained MD to put in my daughters tubes, I wouldn’t want a non-EM trained MD to manage my family member in an emergency room.

Owned!

 

[ntmed]

Malpractice occurrence in emergency medicine: does residency training make a difference?

Thanks for clarifying this. I agree that training makes a difference. However, the OP was not asking about training vs. no trainnig. He was asking about fellowship training leading to BCEM certification.

 

[roja]

For which he was awnsered. In various ways by various people. And this was a general response regarding a trollish issue brought up regarding the need for *any* training in the ED.

 

[dr.smurf]

ill address the original post since this has proved to be a sensitive subject. i dont know if its b/c our em colleagues feel threatened or what. but, all the person asked in the original post was about a fellowship to help him/her feel more comfortable working part-time or whatever in an er while he/she builds a practice. there was never a mention of any back door certification or talk to being equal to a BC EM person if one were to do a fellowship.

yes you can work in an er with or without your fellowship. the truth is there are many small hospital er's outside of the big cities that need staffing. are there enough board certified residency trained em guys? NO Do these guys primarily go out to these small sometimes rural places? Few So there are hospitals out there especially rural ones that would not still be open if it werent for primary care docs staffing them. most of them require a board certified primary care doc with acls, atls, pals. remember these are usually smaller hospitals that dont receive the volume or the traumas inner city hospitals might. so will you be ok with your fp residency and those acls, atls, and pals certfications? 90% yes. and even more so if you were do that fellowship.

good luck..

 

[Whisker Barrel Cortex]

Hmmmm. This sounds oddly similar to emergency physicians performing and interpreting ultrasounds as opposed to radiologists interpreting them.

 

[roja]

Hmmmm. This sounds oddly similar to emergency physicians performing and interpreting ultrasounds as opposed to radiologists interpreting them.

*smacks WBC on the arse* stop trying to stir up trouble.



I'm tired of hearing our radiology residents ask at 4am "why isn't your u/s of the gallbladder good enough" adn then having to explain, "well, yes, I do have 800+ scans but your residency director feels its important for YOU to do scans. Please take it up with them..

 

[Freeeedom!]

I think there is a fundamental question to be asked, if you wanted or planned to work in an ED...why didn't you enter emergency medicine?

I can tell you that "YES" many small ED's hire FP's...but I can also tell you that the ED's that have a combination of FP's and EM docs, the FP's are being pushed out. I can also tell you that large EM groups actively advertise that they ONLY have BC/BE EM physicians and they use this as leverage to gain new contracts.

So to answer your question, yes you can work in an ED as a FP. No, the fellowship will mean very little primarily because it is STILL not a residency and you can not be certified by ABEM/ABOEM. Could you potentially work in an urgent care...HELL YEAH.

As for ultrasounds, the truth is this...do you REALLY want to read a DVT ultrasound or GB ultrasound in the middle of the night? Standards of care are changing and it doesn't involve radiologists approving ultrasounds...it involves EM physicians doing the initial screening and just getting the correct test.
I have a fantastic relationship with our rads residents...I think they understand and they don't mind doing LESS work. ED's are simply too busy anymore to slow the whole process down by waiting for the radiologists.

 

[srlondon]

Emergency medicine is the newest recognized specialty in medicine. With the advent of each specialty and sub-specialty there was a transition period when there were people who were grandfathered into specialty who were allowed to continue their practice. The birth of each board specialty brought with it a new standard of training. You wouldn't accept a gynecologist trying to work as a cardiologist these days. Neither should you expect an IM/FP/surgeon trying to work in the ED outside their specific area of training.

Not even closely paralleled, skippies.

Answer this: Of all the emergency departments in all the hospitals in this country, how many of these "emergency physicians" actually graduated from an accredited emergency medicine residency program and how many of them are board certified by the ABEM?

(I guess the rest aren't qualified...)