EM FM boarded

[Kach]

Hey all, just wanted to give an update. I'm officially emergency medicine boarded through ABPS. I now practice full time EM medicine at a level 2 emergency department, while also taking advantage of FM to work as a full time hospitalist.

When I first matched into family medicine I was very disappointed. I wanted to become an anesthesiologist or perhaps even a pulmonologist. I still love those fields, but I'm very happy with FM. My board certification is attached. Just wanted to inform all you FM residents that FM can be an amazing career. If you have any questions please let me know.

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[Make Or Break]

 

[kingston99]

Thanks for sharing, it is encouraging to see FM docs in diverse clinical settings. I am an FM PGY 3 looking to get into hospitalist medicine. There has been some pushback from recruiters, hopefully, it works out.

 

[sylvanthus]

 

[AGK821199999]

Hi there! Congratulations on your EM fellowship. Would you mind sharing which EM fellowship did you complete? Thanks

 

[AlbinoHawk DO]

I know this is old (2022), but anyone that knows, how seriously is ABPS taken? Are most insurance companies okay with it?

 

[Kach]

Em Fellowship and abps certification can help a family doc a job in a higher level ed. Has nothing to do with billing.

 

[Lexdiamondz]

I know this is old (2022), but anyone that knows, how seriously is ABPS taken? Are most insurance companies okay with it?

It's not taken seriously at all. Practically speaking it opens no new doors to non-EM trained physicians looking to practice EM.

It's not an equivalent board, and the requirements for certification through that route are laughably meagre. Basically if you practice anywhere that calls itself an ED (no matter how low acuity) and write 10 case reports over 3 years you're "board certified".

It's also odd that OP states they work full time as both ED and Hospitalist staff at a Level 2 when both gigs usually are busy enough that you can't do both simultaneously.

 

[Kach]

It's not taken seriously at all. Practically speaking it opens no new doors to non-EM trained physicians looking to practice EM.

It's not an equivalent board, and the requirements for certification through that route are laughably meagre. Basically if you practice anywhere that calls itself an ED (no matter how low acuity) and write 10 case reports over 3 years you're "board certified".

It's also odd that OP states they work full time as both ED and Hospitalist staff at a Level 2 when both gigs usually are busy enough that you can't do both simultaneously.

I am fm with abps certification. It opens lots of doors and I have the paycheck and cv to prove it.

It is not abem residency with all respect to my abem colleagues, but does require a 1-year fellowship and a challenging written and oral exam. I have no idea how hard it is compared to abems exam. As for Calling another board laughable .. I think that's unnecessarily rude. Instead it is a viable option for fms to get formalized training in the ed instead of going back to residency which is tough for a number of reasons.

Please do not let an anonymous hater discourage you from going from fm to em. EM is too lucrative and too much fun to take this advice.

As for working as both a hospitalist/telehospitalist and as an em doc, this is the advantage of fm training.

 

[VA Hopeful Dr]

I am fm with abps certification. It opens lots of doors and I have the paycheck and cv to prove it.

It is not abem residency with all respect to my abem colleagues, but does require a 1-year fellowship and a challenging written and oral exam. I have no idea how hard it is compared to abems exam. As for Calling another board laughable .. I think that's unnecessarily rude. Instead it is a viable option for fms to get formalized training in the ed instead of going back to residency which is tough for a number of reasons.

Please do not let an anonymous hater discourage you from going from fm to em. EM is too lucrative and too much fun to take this advice.

As for working as both a hospitalist/telehospitalist and as an em doc, this is the advantage of fm training.

Nah, there are definitely boards we should mock. Looking at you ABPAS.

I don't know about about ABPS to say much other than it seems its main purpose is to offer a back door board certification into EM for people who didn't do an EM residency. That immediately makes me a bit suspicious.

Also I strongly object to EM being super lucrative theses days. First, their income is dropping quite a bit the last few years. Second, I make more per hour than lots of EPs these days doing outpatient FM.

 

[Kach]

Nah, there are definitely boards we should mock. Looking at you ABPAS.

I don't know about about ABPS to say much other than it seems its main purpose is to offer a back door board certification into EM for people who didn't do an EM residency. That immediately makes me a bit suspicious.

Also I strongly object to EM being super lucrative theses days. First, their income is dropping quite a bit the last few years. Second, I make more per hour than lots of EPs these days doing outpatient FM.

OK

 

[Splenda88]

Nah, there are definitely boards we should mock. Looking at you ABPAS.

I don't know about about ABPS to say much other than it seems its main purpose is to offer a back door board certification into EM for people who didn't do an EM residency. That immediately makes me a bit suspicious.

Also I strongly object to EM being super lucrative theses days. First, their income is dropping quite a bit the last few years. Second, I make more per hour than lots of EPs these days doing outpatient FM.

ABPS is making a lot inroad because many physicians are tired of ABMS money scheme. It seems like some hospitals are starting to accept that board for IM.

EM is still lucrative in many place, especially small cities/towns. It was ridiculous 5+ years ago when these docs were making $350+/hr. Most of us knew that was not sustainable. They are are still making $275+/hr now, which is still a lot per hour than most specialties.

 

[VA Hopeful Dr]

ABPS is making a lot inroad because many physicians are tired of ABMS money scheme. It seems like some hospitals are starting to accept that board for IM.

EM is still lucrative in many place, especially small cities/towns. It was ridiculous 5+ years ago when these docs were making $350+/hr. Most of us knew that was not sustainable. They are are still making $275+/hr now, which is still a lot per hour than most specialties.

That's right about what I make

 

[Splenda88]

That's right about what I make

You are doing extremely well as an outpatient as a FM/IM docs. It seems like most are making 225-275k/yr working M-Th or M-F

 

[Kach]

First world problems, fam. We're all doing well. EM is amazing. I also enjoy locums money. BTW, 1099 is a total cheat code.

 

[VA Hopeful Dr]

You are doing extremely well as an outpatient as a FM/IM docs. It seems like most are making 225-275k/yr working M-Th or M-F

That's either an issue with efficiency or poor support from their employer.

I'm not even in the top 10% of my medical group anymore as I slowed down some a few years ago.

 

[AlbinoHawk DO]

Thanks to everyone that responded. I think everyone knows that FM + Fellowship is not the same as EM, but I'm glad it works out for some people as these doctors can help in rural areas

ABPS is making a lot inroad because many physicians are tired of ABMS money scheme. It seems like some hospitals are starting to accept that board for IM.

ABMS is a complete scam. This is why I think I'll hold onto my NBOME. Creating no competition for ABMS will mean more stupid requirements and fees that shouldn't exist

 

[Splenda88]

Thanks to everyone that responded. I think everyone knows that FM + Fellowship is not the same as EM, but I'm glad it works out for some people as these doctors can help in rural areas



ABMS is a complete scam. This is why I think I'll hold onto my NBOME. Creating no competition for ABMS will mean more stupid requirements and fees that shouldn't exist

It pisses me off every time I am sending that yearly $220 despite getting a reimbursement from my job.

 

[Kach]

Thanks to everyone that responded. I think everyone knows that FM + Fellowship is not the same as EM, but I'm glad it works out for some people as these doctors can help in rural areas



ABMS is a complete scam. This is why I think I'll hold onto my NBOME. Creating no competition for ABMS will mean more stupid requirements and fees that shouldn't exist

Yes, all respect to my colleagues who did an er residency. It's not easy, bro.

As for where we work, we work any where and everywhere. That said, I work in a suburb but I do locums in the boonies once every couple months as it is very lucrative.

Is abms a scam? I guess, but what isn't a scam? But at least we as docs got a job at the end.

 

[Splenda88]

Thanks to everyone that responded. I think everyone knows that FM + Fellowship is not the same as EM, but I'm glad it works out for some people as these doctors can help in rural areas

Would you say the same thing if it was an FM + 18-24 months EM fellowship at Jackson Memorial Hospital (University of Miami)?

 

[Kach]

Would you say the same thing if it was an FM + 18-24 months EM fellowship at Jackson Memorial Hospital (University of Miami)?

That sounds like amazing training.

 

[Splenda88]

That sounds like amazing training.

I ask the question because EM people believe you can practice EM ONLY if you do an EM residency.

In my opinion, EM should have been a 1-2 yr fellowship from FM and possibly IM. 80%+ of what come to my hospital ED (level III trauma) can be treated by an FM doc whose residency was inpatient heavy.

 

[Kach]

I ask the question because EM people believe you can practice EM ONLY if you do an EM residency.

In my opinion, EM should have been a 1-2 yr fellowship from FM and possibly IM. 80%+ of what come to my hospital ED (level III trauma) can be treated by an FM doc whose residency was inpatient heavy.

Again, respect to our em res colleagues. There's a reason why em is a 3 and 4 year residency. There's a lot I had to learn on the job or got help from my em residency colleagues.

The point of this thread is to inform fm doctors that you can have a viable career in the ed. Not to insult our colleagues.

 

[AlbinoHawk DO]

Would you say the same thing if it was an FM + 18-24 months EM fellowship at Jackson Memorial Hospital (University of Miami)?

I don't know. I've met a few graduates from the Texas Permian Basin program. Good people doing their best, but you can tell the difference with people that were trained in straight EM. Maybe it was the program itself and not the training. I don't know at what point you can make FM + fellowship equal to EM residency.

 

[Lexdiamondz]

Would you say the same thing if it was an FM + 18-24 months EM fellowship at Jackson Memorial Hospital (University of Miami)?

24 months at a Level 1 trauma centre after a 3 year FM residency is basically the same as a combined EM-FM residency so sure. The reality though is that the overwhelming majority of "EM Fellowships" are not at trauma centres or anything remotely resembling a high-acuity environment. It's better than nothing but still inadequate for good training.

I ask the question because EM people believe you can practice EM ONLY if you do an EM residency.

In my opinion, EM should have been a 1-2 yr fellowship from FM and possibly IM. 80%+ of what come to my hospital ED (level III trauma) can be treated by an FM doc whose residency was inpatient heavy.

2 year fellowship? sure. 1 year fellowship? woefully inadequate.


I do my own intubations, lines, sedations and vent management but most anesthesia folks would laugh at the idea that I could be an anesthesiologist in a year.

I do my own echos, literally interpret 20+ EKGs a day, manage dysrhythmias, perform cardioversions & start patients on antihypertensives but most cardiologists would be highly skeptical of the notion that I could become a non-invasive cardiologist in a year.


There are nuances to many specialties that you really only pick up with time. You aren't paid a premium as a board-certified physician to deal with the bread and butter - 70-80% of that could be handled by a midlevel with a year of experience. You're paid for the 20-30% that is atypical, uncommon or unexpected and that requires more time, more reps and more mentoring that what you would get in an unaccredited fellowship at some podunk hospital trying to capitalize on cheap labour.

 

[Splenda88]

24 months at a Level 1 trauma centre after a 3 year FM residency is basically the same as a combined EM-FM residency so sure. The reality though is that the overwhelming majority of "EM Fellowships" are not at trauma centres or anything remotely resembling a high-acuity environment. It's better than nothing but still inadequate for good training.


2 year fellowship? sure. 1 year fellowship? woefully inadequate.


I do my own intubations, lines, sedations and vent management but most anesthesia folks would laugh at the idea that I could be an anesthesiologist in a year.

I do my own echos, literally interpret 20+ EKGs a day, manage dysrhythmias, perform cardioversions & start patients on antihypertensives but most cardiologists would be highly skeptical of the notion that I could become a non-invasive cardiologist in a year.


There are nuances to many specialties that you really only pick up with time. You aren't paid a premium as a board-certified physician to deal with the bread and butter - 70-80% of that could be handled by a midlevel with a year of experience. You're paid for the 20-30% that is atypical, uncommon or unexpected and that requires more time, more reps and more mentoring that what you would get in an unaccredited fellowship at some podunk hospital trying to capitalize on cheap labour.

I am not advocating for people to do to fellowship at podunk hospital and claim they are as good as the average EM doc...

The sentiment that I notice in the EM forum is that they think even good 2-yr EM fellowship at a major university hospital would not be enough to practice EM safely because 2-yr of fellowship would not be enough to have the EM doc mindset...whatever that means. I think that reasoning is nonsense.

I agree with your other points.

 

[Lexdiamondz]

I am not advocating for people to do to fellowship at podunk hospital and claim they are as good as the average EM doc...

The sentiment that I notice in the EM forum is that they think even good 2-yr EM fellowship at a major university hospital would not be enough to practice EM safely because 2-yr of fellowship would not be enough to have the EM doc mindset...whatever that means. I think that reasoning is nonsense.

I agree with your other points.

Firstly, I've never encountered anyone on that forum who espoused the idea that a 2 year fellowship in EM is not enough to practice EM when combined EM/IM and EM/FM programs are 5 years total, and a 2 year fellowship in EM after a 3 year residency gives you the same total length of training.

Secondly, mindset matters nearly as much as clinical knowledge depending on the setting you work in. On any busy service, whether that be in the ED, the floor or the ICU, there are nuances to efficient and efficacious daily practice that come with time and experience. Part of the EM mindset is prioritizing working up emergent pathology versus what is likely pathology, triaging large volumes of undifferentiated patients, minimizing medicolegal exposure while maintaining throughput and customer satisfaction.

80% of the chief complaints in an ER are stuff that an IM or FM doc could easily handle but the tricky part is doing it while seeing 2-3 new patients per hour, being constantly interrupted, never missing life-threatening chief complaints while keeping patients, consultants and admin happy and occasionally having to cric someone, deliver a baby or declare someone dead.

 

[AGK821199999]

It's not taken seriously at all. Practically speaking it opens no new doors to non-EM trained physicians looking to practice EM.

It's not an equivalent board, and the requirements for certification through that route are laughably meagre. Basically if you practice anywhere that calls itself an ED (no matter how low acuity) and write 10 case reports over 3 years you're "board certified".

It's also odd that OP states they work full time as both ED and Hospitalist staff at a Level 2 when both gigs usually are busy enough that you can't do both simultaneously.

We all know it is all about the money! ED docs call non-EM trained not qualified while leave their ED to mid levels to run and write poems about how qualified they are because they are cheap ? Come on bro, we are not med students anymore ! Also we are FM docs talking about a topic why you don’t stay in your lane ? When I come ask for a job at your hospital then you can say no( that is your only business in that matter). You want to say you are the best doc in the world and you can do everything? Great good for you and we are happy to have you in the world but this is not helping us discussing this topic ! Thanks

 

[Lexdiamondz]

We all know it is all about the money! ED docs call non-EM trained not qualified while leave their ED to mid levels to run and write poems about how qualified they are because they are cheap ? Come on bro, we are not med students anymore ! Also we are FM docs talking about a topic why you don’t stay in your lane ? When I come ask for a job at your hospital then you can say no( that is your only business in that matter). You want to say you are the best doc in the world and you can do everything? Great good for you and we are happy to have you in the world but this is not helping us discussing this topic ! Thanks

Oh look, a hit dog that decided to holler.

 

[VA Hopeful Dr]

We all know it is all about the money! ED docs call non-EM trained not qualified while leave their ED to mid levels to run and write poems about how qualified they are because they are cheap ? Come on bro, we are not med students anymore ! Also we are FM docs talking about a topic why you don’t stay in your lane ? When I come ask for a job at your hospital then you can say no( that is your only business in that matter). You want to say you are the best doc in the world and you can do everything? Great good for you and we are happy to have you in the world but this is not helping us discussing this topic ! Thanks

My impression has been most EPs don't actually like the increasing midlevel presence in the ED. One or two for fast track stuff? Sure. Anything more than that usually isn't well received.

I would also argue that getting a perspective from EPs on FPs doing EM fellowships is valuable.

 

[AGK821199999]

Oh look, a hit dog that decided to holler.

Sorry, no one told you manners is part of the job even if it is not part of board requirements 😬

 

[AGK821199999]

My impression has been most EPs don't actually like the increasing midlevel presence in the ED. One or two for fast track stuff? Sure. Anything more than that usually isn't well received.

I would also argue that getting a perspective from EPs on FPs doing EM fellowships is valuable.

Maybe that is your impression and I respect it but in real life we all have seen that EDs are more equipped with mid-levels than docs now! Urgent care are only mid-levels at least where I practice.
Some family docs are getting the training to help their rural communities for their patients to get better care! A doc practice under his medical license and should have insight of what he can/can’t do. If you are FM trained with heavy ED training in a community hospital and you feel comfortable running/supporting in the ED then sure! Or get extra training to be comfortable and know your limits! We are forever learners! Learning doesn’t stop after residency.
We should end that toxic mentality in medicine of docs competing who is better and putting others down.
I agree to get anyone’s opinion on any matter if it is related to the topic and positive! Like, you think something is not right, recommend how to fix it instead of acting like “ hey, my grades are better than yours” kind of mentality 😅😅

 

[VA Hopeful Dr]

Maybe that is your impression and I respect it but in real life we all have seen that EDs are more equipped with mid-levels than docs now! Urgent care are only mid-levels at least where I practice.
Some family docs are getting the training to help their rural communities for their patients to get better care! A doc practice under his medical license and should have insight of what he can/can’t do. If you are FM trained with heavy ED training in a community hospital and you feel comfortable running/supporting in the ED then sure! Or get extra training to be comfortable and know your limits! We are forever learners! Learning doesn’t stop after residency.
We should end that toxic mentality in medicine of docs competing who is better and putting others down.
I agree to get anyone’s opinion on any matter if it is related to the topic and positive! Like, you think something is not right, recommend how to fix it instead of acting like “ hey, my grades are better than yours” kind of mentality 😅😅

Just because you're seeing it doesn't mean the doctors in the ED are happy about it. Unless its a private EM group, then the doctors don't get much say in who works there.

The vast majority of urgent cares are corporate owned. Doctors don't get to say who does and doesn't work there.

Physicians have a nasty habit of not knowing their limits.

 

[Lexdiamondz]

Sorry, no one told you manners is part of the job even if it is not part of board requirements 😬

I simply reflect the tone given to me. I'm not sorry.

 

[AGK821199999]

I simply reflect the tone given to me. I'm not sorry.

I’m not expecting you to be sorry. Look at all your comments. Nothing personal against me I completely understand. Again called manners, I’m sorry for you. So sorry you missed this despite all years of education! See you in next life mate !

 

[Splenda88]

Physicians have a nasty habit of not knowing their limits.

Disagree. Maybe the people I have worked with since med school are different.

 

[Lexdiamondz]

I’m not expecting you to be sorry. Look at all your comments. Nothing personal against me I completely understand. Again called manners, I’m sorry for you. So sorry you missed this despite all years of education! See you in next life mate !

We all know it is all about the money! ED docs call non-EM trained not qualified while leave their ED to mid levels to run and write poems about how qualified they are because they are cheap ? Come on bro, we are not med students anymore ! Also we are FM docs talking about a topic why you don’t stay in your lane ? When I come ask for a job at your hospital then you can say no( that is your only business in that matter). You want to say you are the best doc in the world and you can do everything? Great good for you and we are happy to have you in the world but this is not helping us discussing this topic ! Thanks

Friend, you had the audacity to tell me to "stay in my lane" in a thread about a bunch of folks trying to get a backdoor route into board certification in a specialty they didn't train for...and then had the audacity to say I lack manners for not taking kindly to your unhinged ranting.

Absolute stupidity.

 

[VA Hopeful Dr]

Disagree. Maybe the people I have worked with since med school are different.

It's not a universal thing, but it's pretty common

 

[Splenda88]

It's not a universal thing, but it's pretty common

It is not common IMO. I think most physicians are actually too cautious because they are afraid to get sued.