- Joined
- Dec 4, 2011
- Messages
- 1,847
- Reaction score
- 2,515
Good luck, black dynamite.
And apologies if I said anything offensive.
And apologies if I said anything offensive.
Thanks for this suggestion. I'm monitoring the website frequently. There are only 2 posts right now. One for PGY-1 and one for PGY-2. They both look outdated!Try the SAEM webpage, spots open up after the match (and you might get some credit for the rotations you finished).
This is ridiculous.
OP had no chance to match EM. Should be happy with FM - lots of variety.
Perhaps if interested in EM, maybe get experience or fellowship, then apply for EM residency.
I'm surprised anyone at his institution gave him potential advise to switch mid-residency.
OP, if (as some people are saying above) FM working in ED usually pays similar rates to EM, then FM seems like a good way to go.
Only real issue seems to be if more hospitals in the future will require BC/BE EM instead. No idea how likely this is though? Maybe it means you'll only be able to work rural?
Off-service residents do not get treated the same as EM residents, even EM interns. Off-service residents are treated as extra's, and just see whatever number of patients they want to see and whichever patients they want to see. Moreover, they are excluded from seeing the sicker patients. Having a structured EM residency is what allows you to ascend the ranks of responsibility. So, even if you theoretically spent an equal number of days as a non-EM resident in the ER, you still wouldn't get the same experience. Not even close.
There is a new FL program that is recruiting PGY 1 and 2 residents.
Hey OP.
I was in a similar situation to you last year except I extended my graduation and reapplied and matched to a less competitive specialty (IM) rather than matching into FM. I had low boards but passed both on 1st attempt and didn't take an LOA. Feel free to PM if you'd like any advice or if you'd just like to share. I'm not sure I could offer more practical advice than what the previous posters have already given but it may help to talk to someone who has been in a similar situation. Best of luck to you whatever route you take.
I know this is a slight deviation from the topic, but has there been any more talk about fellowship programs in EM for those with FP or IM background? I know this has been a hot button topic in recent years with the ABEM being strongly opposed to such things. My understanding is that the ABPS does recognize these fellowships and considers them "board certified" via their own board certification process. Apparently some states recognizes this board certification and some states don't and there have been several legal battles to decide this. I understand that the ABEM is trying to protect the integrity of their specialty and feel that the only way someone should be able to work in the emergency department is after completing an official emergency medicine residency. However, there is obviously a fairly decent sized population of FP and IM graduates out there who would be interested in being able to get board certified in emergency medicine. Instead of having these board certified and licensed physicians drop back down into the match and compete with applicants who still have a full residency's worth of federal funding going for them, why not offer an alternate route to allow for previously trained physicians to work in the ED as board certified emergency medicine doctors. Obviously there is a significant amount of overlap between the two specialties as they are already willing to knock off 6 months worth of residency training for EM residencies for those are also getting IM training. If my memory serves me correctly, I've read that the projected shortage of EM doctors is so significant that the U.S. is not expected to have enough EM docs until around the year 2050. IM and FP are obviously more than qualified to handle anything on the medicine side of things that rolls through the ED (i.e. your COPD and heart failure exacerbations, PNA, AMS, pancreatitis, diabetic ketoacidosis, CP, etc...). I feel that instead of making them go back and complete a whole second residency why not offer a way for them to get the trauma training and surgical/ emergency issue management skills needed in order to be able to sit for the boards?? Make it a 2 year program... most medicine fellowships are 2- 3 years anyway. There are already programs out there like this, but they are just being shunned by the ABEM. I don't get it, are they just trying to protect their turf or something?? Any thoughts or information about this would be greatly appreciated.
I know this is a slight deviation from the topic, but has there been any more talk about fellowship programs in EM for those with FP or IM background? I know this has been a hot button topic in recent years with the ABEM being strongly opposed to such things. My understanding is that the ABPS does recognize these fellowships and considers them "board certified" via their own board certification process. Apparently some states recognizes this board certification and some states don't and there have been several legal battles to decide this. I understand that the ABEM is trying to protect the integrity of their specialty and feel that the only way someone should be able to work in the emergency department is after completing an official emergency medicine residency. However, there is obviously a fairly decent sized population of FP and IM graduates out there who would be interested in being able to get board certified in emergency medicine. Instead of having these board certified and licensed physicians drop back down into the match and compete with applicants who still have a full residency's worth of federal funding going for them, why not offer an alternate route to allow for previously trained physicians to work in the ED as board certified emergency medicine doctors. Obviously there is a significant amount of overlap between the two specialties as they are already willing to knock off 6 months worth of residency training for EM residencies for those are also getting IM training. If my memory serves me correctly, I've read that the projected shortage of EM doctors is so significant that the U.S. is not expected to have enough EM docs until around the year 2050. IM and FP are obviously more than qualified to handle anything on the medicine side of things that rolls through the ED (i.e. your COPD and heart failure exacerbations, PNA, AMS, pancreatitis, diabetic ketoacidosis, CP, etc...). I feel that instead of making them go back and complete a whole second residency why not offer a way for them to get the trauma training and surgical/ emergency issue management skills needed in order to be able to sit for the boards?? Make it a 2 year program... most medicine fellowships are 2- 3 years anyway. There are already programs out there like this, but they are just being shunned by the ABEM. I don't get it, are they just trying to protect their turf or something?? Any thoughts or information about this would be greatly appreciated.
You answered your own questions, twice - ABEM is attempting to protect our interests. By allowing other groups to claim that they also offer board certification, they weaken the integrity of our specialty as a whole. How is this not obvious to everyone?
One of the early obstacles at the beginning of our specialty was convincing the House of Medicine that EM is not something that "anyone could do." This brings me to another point you brought up about IM or FM trained physicians managing certain conditions in the ED - it is not that they lack the knowledge (that absolutely has not been my experience); rather, it is the mindset of working up these chronic diseases in an acute setting with an eye towards what will either harm the pt immediately vs what is most likely going on, while simultaneously managing a dozen other pts. Despite requiring essentially the same knowledge base, it needs to be applied differently and I think that the folks that like one versus another self select into EM vs IM/FM. Again, this isn't to say that an FP can't think like an EP; it's just that in order for an FP to practice EM, they need to do an EM residency. This is no different than if an FP wanted to do general surgery; they can have the knowledge, the stamina, the "surgical mindset," but until they have completed a GS residency, they are still just someone who thinks they could do surgery, rather than someone who is a surgeon.
If you want to practice type-X specialty, you need to do that specialty's training program. Giving any credibility to alternate pathways undermines both the specialty and those of us who choose to practice it.
Yes there's overlap, but there's overlap in every field. I would argue that EM docs are way more qualified than IM docs to become cariologists, would become great interventional radiologists, see a ton of psych and could probably learn to be a psychiatrist in a year or two, etc.
The fact of the matter is, each field protects itself and its board so the individual feel doesn't get over saturated. There are fellowships out there for FP. They're just not ABEM boarded. And hopefully they never will be IMO. I have a skill set for EM that is greater than an FP doc with a 1 year fellowship, and I deserve to be paid more than them. I dont want the market watered down and the boards considered equal. All specialties do this in terms of protecting their boards.
As for the statement that IM an FP doctors could walk into an ER and take care of any of the medical problems, I'm still laughing at that statement. An IM or FP senior resident rotating in the ED handles a patient load less than an ED intern. Procedurally, these residencies do not train residents to do the number of critical care procedures to be anywhere close to competent. And IM never sees a child. And how many have taken a foreign body out of an eye, reduced a fracture or dislocation, are credentialed in procedural sedation, do bedside US, etc. and its not just exposure to all this different stuff, but learning to manage the chaos in a productive manner. That takes years to do.
EM isnt medicine and trauma. It's medicine, surgery, trauma, ophthalmology, OB/GYN, Pediatrics, psychiatry, radiology (US and read your own films at night), cardiology, orthopedics, etc. The list goes on. Its the acute stuff of every field, and the only field that you experience stuff and have to know how to put out fires for every field of medicine.
In the end you can work in EM without a fellowship after an FP residency. Or you could do a fellowship. You can still work in EM. You just cant call yourself ABEM certified. If that is important to you, you'll have to do an EM residency. This is no different than an FP doc who does a dermatology fellowship or an OB fellowship. It's extra training for the FP doc, but they cant start saying they are boarded OB/GYNs either.
Let me clarify... I am not suggesting that IM/FP should be eligible to sit for emergency medicine boards with their current training, but obviously there are barriers to going back and doing a second residency. One commonly brought up issue is funding... Uncle Sam does not want to foot the full bill for doctors to do a second residency. This makes many residency programs hesitant to accept those with previous training. All I am suggesting is that there be an alternate route for those physicians who decide later in life that they would like the additional certification (which would include being trained in emergency management in all the areas that you stated above). Instead, I see people suggesting that FP or IM docs go find a rural ED somewhere where they are more likely to be hired... Sounds like a great alternative. Most Emergency medicine residencies are 3 year programs...Why not offer a 2-3 year fellowship program from those with previous training so that they can acquire the right mindset for an emergency setting and become qualified to remove foreign bodies, work with peds, deal with chaos, handle surgical issues etc....One that makes them Board eligible. That way you don't have less than qualified people running amok in the rural EDs of America. I would argue that this would be in the best interest of the patients in these rural areas, wouldn't you? Previously trained IM physicians who successfully go back and do EM are often only required to complete 2.5 years of residency... Why not offer a fellowship program of equal length for those who decided later in life that they are better suited for the ED but are unable to get a residency due to GME funding issues and red tape.
Funding issues are usually not a big deal at most places. It is a commonly cited, but commonly misunderstood issue. TBH, the greater obstacle preventing people from applying to ACGME programs isn't that the program has to pay, it is that the attending IM/FM doc is going to have to get kicked back down to PGY-1 pay. By going to a non-ACGME accredited fellowship, they are not limited to the ACGME's resident pay structure.
The reality is that people who went IM/FM when they actually wanted EM is often because they were not competitive in their application year. Their inability to get an EM spot after graduation is usually not due to funding issues. It is true that there is a small handful of folks who realize too late that they simply chose wrong, but then we are back to the concept of protecting the specialty.
No program is going to go through the hassle of creating a 2.5 year fellowship. It would be easier for all parties to just go through a second residency. Also, just to be clear, the only reason prior grads from any specialty get 6m credit is because the PD is being kind.
While I understand where you're coming from, this statement is patently false. I have yet to see an IM or FP resident or attending who is "more than qualified" to handle ALL OF the acute medical issues that roll though the ED. Can they handle anything that is medical floor-bound? Sure. How about the CHF septobomb who is failing BiPAP and requires emergent intubation and CVL placement? Procedural competency aside, outside of critical care IM docs, many of the IM attendings I've worked with have been very uncomfortable handling an unstable or crashing patient, even when compared to some some junior EM residents.IM and FP are obviously more than qualified to handle anything on the medicine side of things that rolls through the ED (i.e. your COPD and heart failure exacerbations, PNA, AMS, pancreatitis, diabetic ketoacidosis, CP, etc...).
Funding issues are usually not a big deal at most places. It is a commonly cited, but commonly misunderstood issue. TBH, the greater obstacle preventing people from applying to ACGME programs isn't that the program has to pay, it is that the attending IM/FM doc is going to have to get kicked back down to PGY-1 pay. By going to a non-ACGME accredited fellowship, they are not limited to the ACGME's resident pay structure.
The reality is that people who went IM/FM when they actually wanted EM is often because they were not competitive in their application year. Their inability to get an EM spot after graduation is usually not due to funding issues. It is true that there is a small handful of folks who realize too late that they simply chose wrong, but then we are back to the concept of protecting the specialty.
No program is going to go through the hassle of creating a 2.5 year fellowship. It would be easier for all parties to just go through a second residency. Also, just to be clear, the only reason prior grads from any specialty get 6m credit is because the PD is being kind.
Totally agree. Funding is not an issue at many places. Many hospitals are way over their GME allotted slots. We fund 50% of our ED resident slots through our budget. Its not as big of a deal as many would make it seem.
Thank you both for your insight. You've both been very helpful. Just a man looking for answers...
If you don't mind, Let me pick your brains for just a few more minutes.
Lets say, "hypothetically speaking", that a PGY 1 or 2 resident in IM has an interest in Emergency Medicine. He did not truly get to experience EM until late in his 4th year of medical school and it was too late to apply. He would like to make the switch the best way possible. What is the best way for him to go about this? If funding is truly not that big of an issue, should he just go ahead and finish IM and get that board certification first instead of leaving his current residency program 1 resident short? Would this make him in the least bit more competitive when applying for the second residency? Or, should he just cut his losses, explain the situation to his PD, and apply for EM while he still has a year or 2 of full GME funding left. I know leaving a training program half way through can't look good. He is willing to finish current residency if needed. Maybe use all of his elective months to work in the ED? As far as his competitiveness, he was an average to slightly above average medical student with step scores of 235 and 240, partook in a handful of reputable extra-curricular activities, and has minimal research (a few case reports/poster presentations). Also, what about attempting to transfer into a local EM/IM residency? Do you think one of these options is more feasible/likely than the others? Greatly appreciate the input.
There are so many variables that are individual to each person, it is impossible to offer good advice over the webs. If you have an EM program at your institution, I'd speak to the PD about the logistics. Once you have those things figured out, I'd make friends the EM residents because they can make or break your application (although this probably varies with programs). If you do not have access to an EM program, you could consider cold-calling/emailing PDs or go to the residency fairs at ACEP and SAEM. At some point you need to tell your PD; depending on your relationship with them and their personality, they could very well offer a lot of help with this.
Found out Friday that I matched into my 1st choice FM program. I was devastated.
Hi All,
This is a throwaway account but I have been a member on these forums since I was in High School. I greatly appreciate any and all advice anyone has to offer. I'm feeling pretty down right now but if brutal honestly is what you have to offer, I'd prefer that than false hope.
Brief Story (please ask for more info, this account won't allow me to be identifiable so I'm happy to give lots more info, I just don't want this to be a long post no one reads):
- A lot of interest in EM apparent from my CV (volunteer FD/EMT for 8 years, Peds-EM research in undergrad)
- Rough start to medical school, took LOA (voluntary, did not actually fail out) and restarted the next year
- Mediocre M1 and M2, passed everything.
- Dismal Step Scores: Failed Step 1, Passed with ~210 on second try, Step 2 ~215, Passed CS
- OK M3 year with Honors on EM elective and High-Pass on Anesthesia (great clinical comments, but test taking crippled me from getting higher than pass most of the time)
- Good M4 year with High Pass on Away 1 in EM, Pass at home institution (where the shelf was worth 55% of our grade, seeing a theme yet?), Honors on Away 2 in EM. Those were all the posted grades before ERAS opened.
- Away 1 interviewed me while I was there, Home institution interviewed me later in the season, Away 2 called me back for an interview 3 months later in December, got one more EM interview from a lower tier place. Also, dual applied into FM and got 4 interviews.
- Found out Friday that I matched into my 1st choice FM program. I was devastated.
Now, I knew that with my stats I needed a backup, but I thought that Away 2 would give me a shot for sure. All the residents and attendings liked me, my clinical comments were stellar, and the rotation coordinator said I had one of the highest clinical scores of any of the students they have ever had there (quite possibly due to the fact that it was my 3rd EM rotation in a row). I knew I wasn't a shoe-in, but I thought I had a good shot.
I spent most of Friday in a very depressed state and had no energy to do anything, but after talking with my Dean and a counselor, I felt better and have been keeping myself busy to try and move forward and not dwell on the past. I know I'm lucky to have a position for next year as there are thousands in a similar spot with no concrete plans for the next year.
My question is this: I'm not ready to give up my dreams of being an EM physician, but I don't know what paths there are going forward for me. No matter what, I have to complete my PGY-1 year in FM so all of the following options are based on that, but I'm hoping that you guys can weigh in on which option(s) are better and make suggestions for any other options that might be out there for me:
Option 1: Re-apply for the match in 6 months
Essentially, start PGY-1 year in FM in July 2016, and try to get a PGY-1 position in EM in July 2017. The issue with this is other than killing it and getting a really good letter from my PD in FM, I don't have much more to offer. Of course the blemishes on my record of my Step Scores can't be changed anyways so there's not much I can do to improve my application unless you guys see something I don't.
Option 2: Re-apply for the match in a year and 6 months.
Finish PGY-1 in FM, start PGY-2, and try to match to a spot in EM in July 2018. Same issues as Option 1 except I now have more experience under my belt.
Option 3: Finish my FM residency, and apply to EM as a second residency.
Not sure how much weight the PDs put into someone wanting to do a second residency and once again, my step scores won't change but I'll be further out from them?
Option 4: Work in outlying ERs as an FM grad for a few years, then re-apply to EM residencies.
Not sure how PDs feel about someone already having had some ER experience as an ER Attending but FM trained. I could even do some EMS medical direction in the meantime to boost my resume (something I wanted to do with an EM residency anyways).
Option 5: Give up on the EM residency. Work at an outlying ER as a FM trained physician and pick up EMS medical direction for some smaller FDs.
This is the ultimate fallback plan for me. I would never be able to work in the city, and in a decade or so when there's enough EM trained physicians to go around, probably not even in a suburb of a big city at a community hospital, but at least I'd get to do what I want to do with my life. And the reality is that in my career, we'll probably never have enough EM trained physicians to staff all the rural ERs.
Option 6: ???
I'm hoping that you all on here can give me some guidance as to what to do next. Part of the reason I am so upset is that I just don't know where to go from here. Certainly the dream can't have ended on Friday, but it sure does feel like it's a thousand miles further away than it was before.
Thanks for any advice you guys can offer.