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[deleted1151036]

Thank you doctors.

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[AlbinoHawk DO]

The thing to keep in mind about small rural hospitals is that any significant traumas are not going to show up in the first place, which I think is the big thing FM training lacks in comparison to EM. EMS is going to take them to a trauma center. If you go to an FM program with good inpatient and critical care training, even without an EM fellowship, you'll be equipped to manage the typical stuff that comes into a rural, critical access hospital just fine, or at least enough to stabilize and ship to somewhere that has the resources they need. Minor traumas/fractures, medical emergencies, urgent care type stuff, etc. FM can certainly do with a rigorous training program.

I both agree and disagree with my experience meeting some FM, IM, and surgery trained doctors now doing EM. The part i agree is that most stuff will be shipped out. The part i don't agree with is that these patients won't hit this rural hospital first. It's important to get training to deal with enough to be able to transfer out. I would say that doing the extra 1 year would be a good idea for someone looking to work in an area with limited access. I think most programs are meant for this as they are generally located in smaller cities

 

[Unskilled Enzyme]

Hello all. M1 here from the middle of nowhere interested in rural FM.

Back home, if you call 911, most of the time, the only person staffing the hospital is either an RN or an FM hospitalist. I’m interested in FM, not EM, but, I’m considering pursuing lots of EM training and an EM fellowship so I could sort of be the doctor in that hospital and manage the inpatient and EM stuff. Threads like this one Board Certification for Family Physicians in Emergency Medicine make it seem like doing any kind of ER work when trained like this is unethical.

I understand that a combined EM/FM residency is perfect for this- but there’s only 3 of those in the country, so my odds of matching into one of those programs is low. I’m not trying to get a job in a big city ER after graduating an FM residency. I’m not arguing that FM docs are as good at EM as EM docs. My question is- is doing the EM fellowship from an FM residency good enough training for me to ethically see patients in a small, rural hospital’s ED?

If any EM docs move where I’m from, I’d be ecstatic. But we haven’t had one yet. My goal here is just to provide an extra service to the community, not replace EM physicians. But if I do the FM-EM fellowship route, will I harm patients?

yes but no? of course you will harm patients, we all will. just study hard, do all your amboss/sketchy/pathoma/uworld/anki, always volunteer for every opportunity to learn, and let go of the rest

 

[BigPikachu]

I’m a rural family physician. If you’re going to be practicing in a rural/remote community and expected to cover the local hospital and its emergency department, I would highly recommend that you have spent at least 12-24 months working in emergency medicine plus 6 months in anaesthesiology or intensive care medicine. This in addition to all the usual generalist skills you need as a good family physician with regards to internal medicine, paediatrics, obstetrics and gynaecology. You’re going to be running resuscitations, dealing with trauma, performing rapid sequence inductions and intubations, potentially by yourself and with hopefully a few experienced nurses or paramedics, and if you’re lucky, you might be able call in another attending or senior resident to help if they’re available. The helicopter or plane from the bigger city hospital is 3+ hours away most of the time, so you’re going to need to stabilise most things before transfer. It’s fulfilling work, but you ought to be prepared for the patients you’ll be caring for in your community. I’d also make sure your ALS, APLS, ATLS, etc. are all up to date.

 

[JacobMcCandles]

Not all bad traumas get brought in by EMS. Some get brought in by private vehicle and they’ll come to the closest hospital which is you. There’s a reason why it isn’t a good idea for EM to practice FM and vice versa. With the difficulty in transferring patients out of rural hospitals these days, you’re going to be managing these critical patients longer than you want.

 

[Lexdiamondz]

I'll give my 2c as an EM trained physician who works in a major trauma center that accepts transfers from small rural ERs staffed by FM folk

Nothing really substitutes EM residency for actual EM practice. That being said, nothing substitutes rural medicine experience for some of the more austere stuff that presents to rural ERs. If your goal is to ultimately practice in that setting, you will need the skills to be able to improvise with the limited resources you have in order to temporize and ship patients with complex problems safely to tertiary and quartenary care centres.

Look into FM programs with rural medicine tracks and unopposed FM programs with attached EM fellowships. They are likely to better prepare you for the job you're looking for.

 

[TooMuchResearch]

The thing to keep in mind about small rural hospitals is that any significant traumas are not going to show up in the first place, which I think is the big thing FM training lacks in comparison to EM. EMS is going to take them to a trauma center. If you go to an FM program with good inpatient and critical care training, even without an EM fellowship, you'll be equipped to manage the typical stuff that comes into a rural, critical access hospital just fine, or at least enough to stabilize and ship to somewhere that has the resources they need. Minor traumas/fractures, medical emergencies, urgent care type stuff, etc. FM can certainly do with a rigorous training program.

I don't entirely agree with this.
We had, including residents and attendings, 5-6 doctors in the room for every stable trauma activation during residency.
When I get an unstable trauma in a rural setting and the patient is too unstable for medics to bypass me for the trauma center, I'm usually the only doctor in the hospital. These patients may need a lot from you in a very little amount of time. If you're not prepared to solo intubate, place bilateral chest tubes, stop any external hemorrhage, run blood, while also working on emergent transport, in a kid, you shouldn't be in the emergency department.

 

[Lexdiamondz]

The thing to keep in mind about small rural hospitals is that any significant traumas are not going to show up in the first place, which I think is the big thing FM training lacks in comparison to EM. EMS is going to take them to a trauma center. If you go to an FM program with good inpatient and critical care training, even without an EM fellowship, you'll be equipped to manage the typical stuff that comes into a rural, critical access hospital just fine, or at least enough to stabilize and ship to somewhere that has the resources they need. Minor traumas/fractures, medical emergencies, urgent care type stuff, etc. FM can certainly do with a rigorous training program.

Yeah I don't really agree with this.

Just because you aren't a trauma centre doesn't mean you won't get major trauma, and when you do you're often stuck managing it yourself as opposed to having an army of trainees to help out. As mentioned previously - if you aren't ready to do every resuscitative procedure you really shouldn't be working in an ER (especially if there's little or no backup).

There are many more differences between EM and FM training besides trauma though - you're talking about 1 month of dedicated ICU time vs. 5 mos, dedicated anesthesia time, orthopedics, trauma and far more regular exposure to resuscitation and management of critically ill patients.