General surgeon moonlighting in the ER

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em2bee

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We had a general surgeon come talk to us today, and he told us that he often moonlights in the ER. This confused me, so I asked him why an EM residency even exists if general surgeons can do everything an EP can do. He told me that general surgeons have all of the "basic medical knowledge" an EP does, but "finished their training" in the GS residency. What are your thoughts?

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Anyone seen the movie Trolls?

I'm not trolling. I'm only an M1 interested in EM, so I really don't know much about either field. He went on to say how ERs actually used to be staffed completely by surgeons before EM split off into its own specialty.
 
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FP and IM or generalist used to staff EM before EM became a specialty of its own I remember. Even nowadays, in rural or non-busy EDs there are a lot of IM or FP guys in EM who are doing the same job fine. However, they probably won't be as good in busy trauma centers due to lack of Resus experience, rest of the medicine isn't out of the world of scope of FP/IM. Never heard if surgeons staffing ED before
 
Many EDs used to be a division of the Dept. of Surgery at the hospital. Some programs like WashU, UW, and Duke are still this way despite having a residency program. That does not mean the practice of EM can be done as well by non EM trained physicians, especially as the field has evolved. That attitude is no different than EM saying it could do most other specialties. Just because EM trains you to manage many acute cardiac events, it doesn't train you to be the best cardiologist because that is not the focus of EM. EM has a very different mindset from other specialties and to be good you don't just need to be the best at resuscitation and rapid diagnosis, but you also have to manage a department with dozens of other patients and a waiting room full of potentially sick people. You become good at what you practice and you need the training you get in residency and the daily practice of EM to be good at EM.
 
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I'm not trolling. I'm only an M1 interested in EM, so I really don't know much about either field. He went on to say how ERs actually used to be staffed completely by surgeons before EM split off into its own specialty.
Go read House of God. And then be quietly thankful that emergentology has become its own specialty. For extra credit, look up either The Rape of Emergency Medicine (free) or Brian Zink's book Anyone, Anything, Anytime. ERs were not *completely* staffed by surgeons, but were often staffed by some mix of surgery, medicine and random people with medical degrees. There are still places covered by a similar mix. There are also surgeons and internists who are grandfathered in to EM and who often have deep wells of wisdom and experience. And it's still a good thing that there is EM-specific training.

Also, go watch Trolls.
 
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We had a general surgeon come talk to us today, and he told us that he often moonlights in the ER. This confused me, so I asked him why an EM residency even exists if general surgeons can do everything an EP can do. He told me that general surgeons have all of the "basic medical knowledge" an EP does, but "finished their training" in the GS residency. What are your thoughts?
He doesn't know what EM is.
 
Totally misread this as "Surgeon General Moonlighting in the ER" haha
 
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I'll repeat a lot of what DocDragon said above (since I didn't notice his post until I had written up most of mine):

EM residencies are relatively new. Before this, ER's were staffed by an assortment of physicians, and often the ER was split between Medicine and Surgery. Eventually, people realized this was not good for patients and slowly the specialty of EM was born. You should read the book by Zink on this (Anyone, Anything, Anytime) to learn about this history of EM, if interested.

Since no EM residencies existed when this specialization took place, many of the forefathers of EM are not EM-residency trained. The old surgeons who still practice EM have often, however, passed the EM boards and "grandfathered" into being EM-board certified. Many of them are, as DocDragon says, "wells of knowledge." Most of them, however, wish that they had had the luxury of EM residencies, and many of them will admit that the new crop of EM-residency trained physicians are better trained and prepared than they were... Conversely, we as the younger docs must always be grateful for what the "EM forefathers" did for our specialty.

Back in the day, a GP in the rural setting could and would do everything. Those times are gone (or almost gone). Now, physicians specialize and sub-specialize, so it is no longer possible or a good idea for a General Surgeon out of residency to become an EM doctor. Almost no ER would hire such a person, and there would be great medico-legal risk involved to do so.
 
We have our own residency, own specialty, and own board for a reason.
 
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We had a general surgeon come talk to us today, and he told us that he often moonlights in the ER. This confused me, so I asked him why an EM residency even exists if general surgeons can do everything an EP can do. He told me that general surgeons have all of the "basic medical knowledge" an EP does, but "finished their training" in the GS residency. What are your thoughts?
You asked the wrong question. You should have asked, "how many spousal support/child support payments do you have to make each month?".

Bonus points for "how many mortgages do you have?".
 
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The community ED I worked in has a board cert surgeon staffing it. He is like in his 60's and went solely into EM shifts like 15-20years ago.


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Totally misread this as "Surgeon General Moonlighting in the ER" haha

That would be odd for sure. What is extremely odd is that the position is now held by an NP!


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That would be odd for sure. What is extremely odd is that the position is now held by an NP!


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ugggh ya. water our degree down

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Yeah, I mean, I could do most of the job of a gen surgeon competantly to0. I could do ED consults and decide who needs to go to the OR, I could round postoperatively, see followup patients in clinic, do pre-ops. Etc. I just cant go operate on someone. Just because I can do parts of the job, that doesn't make me a general surgeon. There's a lot of overlap in all fields of medicine. I bet I see more rashes than any medical field other than Derm, more broken bones other than orthopedics, more STEMIs than the average cardiologist ever sees, etc. The devil is in the details. I'm not qualified to go practice in any of their fields even though I could probably fumble through parts of their jobs.

Unfortunately, there's EDs that just cant get staffing, so they will turn to anyone with an independent license to staff them.
 
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I wish that other departments of the hospital would just let anybody work there. Imagine an OR with an EM doc running anesthesia, and a pathologist doing surgery. Or a NICU run by an OB/GYN. Man, it would be cool.
I also with hospitals would realize it's 2017 though.
 
Even 20 years ago, you could find general surgeons that did GYN. They weren't delivering babies, but women's health, hysts, and onc stuff. When I was in Hawai'i, I heard a story from my boss, who told me of something that occurred a year before I got there (so 2007-2008). My boss had a lady with bad vag bleeding, and there was no OB/GYN at the hospital. She couldn't get a call back from anyone, and it was a time-critical situation. There was a CT surgeon in the hospital, and, recall that CT guys, once they go above the diaphragm, usually NEVER go back. Well, this CT surgeon would cut you neck to nuts, if needed, and he was ready and willing to do a hysterectomy. Finally, my boss got a call back, and an OB/GYN accepted the pt to another hospital (close by).
 
the only person who would think a gen surgeon operating as an ER doc is a good idea is the dude who owns the CT scanner, and maybe the guy who owns the hematology lab because you literally cant diagnose anything without a white count and a stem to stern CT
 
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If we activated every trauma in our ED they would all get pan scans. Don't get me wrong our trauma docs are great but if they saw an ankle sprain they would freaking pan scan this person. I recently called our trauma surgeon with the LOL fall at Walmart with LOC no head bleed but still confused. Called for admission for obs and cog screen in am. First question was did you pan scan? WTF she fell and hit her head. She got a pan scan on admission. This is why we don't have other specialties man the ED. Also if I can neuro I should just put in the order for MRI prior to calling them.
 
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I'm currently doing my rural rotation at a hospital where none of the docs in the ER are EM trained. This has been very evident in the admissions I've been getting, with very incomplete workups. I've had septic pt's admitted without any blood cultures or IV fluids. The worst was a septic pt that was in the ER for 4 hours before they had any labs done, and 10 hours before they got antibiotics.

So yes, you can staff an ER with a non EM trained physician but it is a detriment to the patient because they are getting the short end of the stick in this situation.
 
General surgeons do not know how to take care of patients with HTN without a medicine admit (or consult on occasion), so they'd have a hard time managing anyone in the ER.
 
Today's surgeons are awful at managing. They are good at operating. I just saw a hyperglyemic diabetic patient running d5 NS maintenance on the surgery flloor...
 
C'mon, no need to turn this into a Surgery-bashing thread.

The fact that so many docs feel like they could do our job is a compliment - it reflects the fact that we have the skills to make one of the world's hardest jobs look easy.
 
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Throw a medically sick kid in front of the surgeon and see what happens.
 
I don't think a General Surgeon should be managing a busy ED but we have a few general surgeons who are critical care boarded and they have a rather impressive skill set.. They admit/manage MICU/TICU/SICU patients with all sorts of co-morbidities no problem, then take ACS/trauma call the next day.. your average GB/appy Gen Surg probably admits most complicated medical patients to hospitalists (who wouldn't) but we have a few who are superstars.
 
I think you will be surprised to see that outside of medical academia, or rather the healthcare industry, physician jobs don't always fit into nice ABMS-defined job descriptions. Sometimes there is a surprising amount of deviation. Last year at work someone broke some glass and the glass shard flew off and went completely through the employees cheek/lip, I told him to stay put for a sec (I was the sup) and I come back downstairs with the incident form to bring to the ER and him and another (lazy) employee already absconded to the urgent care clinic down the street where employees are usually told to go. I assumed they would send him to the ER since in my area plastic surgeons see all facial lacs. Turns out there was a "kind of retired" plastic surgeon picking up some shifts at the urgent care, and the employees face remained mucho attractive.
 
Today's surgeons are awful at managing. They are good at operating. I just saw a hyperglyemic diabetic patient running d5 NS maintenance on the surgery flloor...

And I've seen acute CVAs, meningitis, Septic stones, fourniers, etc. languish in an ER for hours without appropriate work up or testing or just be flat out missed in ER. Yet I presume that most ER doctors are competent. We all make mistakes often compounded by systems issues and other circumstances. We do not do our profession any favors by tearing each other down.

But yes I agree with the premise of this thread that docs should stick to their wheelhouse and training when possible.
 
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I think you will be surprised to see that outside of medical academia, or rather the healthcare industry, physician jobs don't always fit into nice ABMS-defined job descriptions. Sometimes there is a surprising amount of deviation. Last year at work someone broke some glass and the glass shard flew off and went completely through the employees cheek/lip, I told him to stay put for a sec (I was the sup) and I come back downstairs with the incident form to bring to the ER and him and another (lazy) employee already absconded to the urgent care clinic down the street where employees are usually told to go. I assumed they would send him to the ER since in my area plastic surgeons see all facial lacs. Turns out there was a "kind of retired" plastic surgeon picking up some shifts at the urgent care, and the employees face remained mucho attractive.

In what scenario does it make sense for a plastic surgeon to make $100/hr working in an UC????
 
In what scenario does it make sense for a plastic surgeon to make $100/hr working in an UC????

Key words; "kinda retired." There are a lot of physicians who have officially retired but don't want to stay home with their wives all day and look to work in an urgent care where they have defined shifts. I think the average age of the physicians at most of our urgent cares in town is about 85. We get calls from a wide range of specialties who are looking for that kind of situation. For the vast majority, the response is "don't call us, we will call you." I am still waiting for a pathologist though; haven't had one of them yet, but that is about it.
 
If i went to a ER and had a gen surg as my EM doc id run away (if im alive to run away). Unless the surgeon has been doing it for years, that'd be awful. I work closely with surgeons and their management skills are subpar. They call cardiology consults for hypertension management and here oftentimes there is a hospitalist on service to help them manage medical problems. It makes sense since their main training is in operating and managing surgical conditions in their field..
 
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I vividly remember giving sign out on the night of one of my residency end-of-year banquets. The dept was going to be staffed by a couple of EM attendings with IM and surgery residents pitching in to give the EM residents the night off.

The surgery chief (who is a brilliant surgeon, BTW) looked at the charts in the rack and the top one was a vag bleeder. The look on his face was priceless. I think one of the IMs took it, but it was certainly a moment I haven't forgotten.
 
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I vividly remember giving sign out on the night of one of my residency end-of-year banquets. The dept was going to be staffed by a couple of EM attendings with IM and surgery residents pitching in to give the EM residents the night off.

The surgery chief (who is a brilliant surgeon, BTW) looked at the charts in the rack and the top one was a vag bleeder. The look on his face was priceless. I think one of the IMs took it, but it was certainly a moment I haven't forgotten.

I still have the same face when I see that chart.
 
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I vividly remember giving sign out on the night of one of my residency end-of-year banquets. The dept was going to be staffed by a couple of EM attendings with IM and surgery residents pitching in to give the EM residents the night off.

The surgery chief (who is a brilliant surgeon, BTW) looked at the charts in the rack and the top one was a vag bleeder. The look on his face was priceless. I think one of the IMs took it, but it was certainly a moment I haven't forgotten.

time to book for emergency ex lap
 
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Any ABEM-boarded guys here believe that non-ER residency trained docs should be able to attain a certification (not specialist/consultant-level certification but a competency-based certificate)?

Not looking for a snide remarks, only interested in sympathetic ears.

We all know that FPs, internists, surgeons provided ER care in many critical access regions without siphoning off jobs from ABEM docs. I recently graduated from an FM-residency and would like to work in the ER but I get pushback even from very rural places with high need for ER docs because their by-laws only allow for board-certified ER docs. I wish that there is a way for non-ER residency trained physicians to get a competency-based, non-specialist level certificate so we can get credentialed to work in the ER. I am talking about something similar to an ABIM and ABFM certificate called RFPHM (Recognition of Focused Practice in Hospital Medicine). It's a certificate that FPs get after working full-time for 3 years as a hospitalist, passed a written exam, get endorsement from the chief of staff from the hospital, and log of 3000 pt encounters.

The Europeans allow ER board certification if boarded in non-ER specialty + 3 yrs of ER experience (EBEEM exam by EuSEM), Canada has the CCFP-EM certification, and Australia has multiple pathways/levels including ACEM/ACRRM/ER certificate/ER diploma. I think that residency training and med school education is evolving so rapidly since the education materials are so widespread and easily attainable that many non-ER residency trained docs can become proficient in ER-centric procedures like chest tubes, intubations, emergency vaginal delivery, central lines, resuscitation that a competency-based certificate should be available to docs who are competent in delivering emergency care.

I am not advancing the case for ABPS BCEM certificate. I am just trying to see if any ABEM docs here would be willing to collaborate with FP, IM, Peds, Surgeons working in the ER for an ABMS-sponsored certification called "Recognition of Focused Practice in Emergency Medicine". A sample eligibility criteria would be: docs who have worked in the ER for 36 months full-time, have at least 3000 pt encounters, procedure logs, and have passed a written exam and OSCE similar to ABEM-material. Again, this may help hospitals gain competent docs and competent docs gain employment in places that need ER care.

thanks
 
Any ABEM-boarded guys here believe that non-ER residency trained docs should be able to attain a certification (not specialist/consultant-level certification but a competency-based certificate)?

Not looking for a snide remarks, only interested in sympathetic ears.

We all know that FPs, internists, surgeons provided ER care in many critical access regions without siphoning off jobs from ABEM docs. I recently graduated from an FM-residency and would like to work in the ER but I get pushback even from very rural places with high need for ER docs because their by-laws only allow for board-certified ER docs. I wish that there is a way for non-ER residency trained physicians to get a competency-based, non-specialist level certificate so we can get credentialed to work in the ER. I am talking about something similar to an ABIM and ABFM certificate called RFPHM (Recognition of Focused Practice in Hospital Medicine). It's a certificate that FPs get after working full-time for 3 years as a hospitalist, passed a written exam, get endorsement from the chief of staff from the hospital, and log of 3000 pt encounters.

The Europeans allow ER board certification if boarded in non-ER specialty + 3 yrs of ER experience (EBEEM exam by EuSEM), Canada has the CCFP-EM certification, and Australia has multiple pathways/levels including ACEM/ACRRM/ER certificate/ER diploma. I think that residency training and med school education is evolving so rapidly since the education materials are so widespread and easily attainable that many non-ER residency trained docs can become proficient in ER-centric procedures like chest tubes, intubations, emergency vaginal delivery, central lines, resuscitation that a competency-based certificate should be available to docs who are competent in delivering emergency care.

I am not advancing the case for ABPS BCEM certificate. I am just trying to see if any ABEM docs here would be willing to collaborate with FP, IM, Peds, Surgeons working in the ER for an ABMS-sponsored certification called "Recognition of Focused Practice in Emergency Medicine". A sample eligibility criteria would be: docs who have worked in the ER for 36 months full-time, have at least 3000 pt encounters, procedure logs, and have passed a written exam and OSCE similar to ABEM-material. Again, this may help hospitals gain competent docs and competent docs gain employment in places that need ER care.

thanks

So why not just pursue an EM residency? I personally would be against something like your suggestion because I want to make sure my future EP colleagues have as many options as possible for jobs. Would you ask any other speciality for a backdoor to slide into their specialty? As a FP you have plenty of options to practice in critical care access hospitals but unfortunately you can't be too picky as far as locale.


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Any ABEM-boarded guys here believe that non-ER residency trained docs should be able to attain a certification (not specialist/consultant-level certification but a competency-based certificate)?

Not looking for a snide remarks, only interested in sympathetic ears.

We all know that FPs, internists, surgeons provided ER care in many critical access regions without siphoning off jobs from ABEM docs. I recently graduated from an FM-residency and would like to work in the ER but I get pushback even from very rural places with high need for ER docs because their by-laws only allow for board-certified ER docs. I wish that there is a way for non-ER residency trained physicians to get a competency-based, non-specialist level certificate so we can get credentialed to work in the ER. I am talking about something similar to an ABIM and ABFM certificate called RFPHM (Recognition of Focused Practice in Hospital Medicine). It's a certificate that FPs get after working full-time for 3 years as a hospitalist, passed a written exam, get endorsement from the chief of staff from the hospital, and log of 3000 pt encounters.

The Europeans allow ER board certification if boarded in non-ER specialty + 3 yrs of ER experience (EBEEM exam by EuSEM), Canada has the CCFP-EM certification, and Australia has multiple pathways/levels including ACEM/ACRRM/ER certificate/ER diploma. I think that residency training and med school education is evolving so rapidly since the education materials are so widespread and easily attainable that many non-ER residency trained docs can become proficient in ER-centric procedures like chest tubes, intubations, emergency vaginal delivery, central lines, resuscitation that a competency-based certificate should be available to docs who are competent in delivering emergency care.

I am not advancing the case for ABPS BCEM certificate. I am just trying to see if any ABEM docs here would be willing to collaborate with FP, IM, Peds, Surgeons working in the ER for an ABMS-sponsored certification called "Recognition of Focused Practice in Emergency Medicine". A sample eligibility criteria would be: docs who have worked in the ER for 36 months full-time, have at least 3000 pt encounters, procedure logs, and have passed a written exam and OSCE similar to ABEM-material. Again, this may help hospitals gain competent docs and competent docs gain employment in places that need ER care.

thanks

Do you know what 3 years of working full time in the ED is called?

The fact that you are looking for an alternative pathway proves the point that ABEM certification is valuable and worth protecting. In comparison to our international colleagues, having a single pathway to EM-board certification is something we are doing right here in the US. Having myriad alternate pathways undermines the legitimacy of our specialty.

I do not believe that just studying procedures via FOAM or YouTube can make someone an ED doc any more than going to counseling can make you a psychiatrist. It can provide insight but it isn't the same thing.
 
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Unfortunately, ER residency is largely not an option after completing another residency because of Medicare funding.

I've had 5 yrs of ACGME residency in 3 specialties and currently in a fellowship...my training has significant ER residency overlap

So why not just pursue an EM residency? I personally would be against something like your suggestion because I want to make sure my future EP colleagues have as many options as possible for jobs. Would you ask any other speciality for a backdoor to slide into their specialty? As a FP you have plenty of options to practice in critical care access hospitals but unfortunately you can't be too picky as far as locale.


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Unfortunately, ER residency is largely not an option after completing another residency because of Medicare funding.

I've had 5 yrs of ACGME residency in 3 specialties and currently in a fellowship...my training has significant ER residency overlap

Just because you have "overlap" does not make you EM trained. Just because you did 2 months in residency in the ER and spent 3 months in the ICU does not mean you have been adequately trained to become BC in our specialty. It's a slap in the face to us to think that just because you have "overlap" in our specialty, that you are somehow qualified to be held on the same level as your colleagues that have spent years training specifically to do the job that we do. I've done 5 months in the ICU, should I be BC intensivist? I've done 200 intubations, you think they'd let me be an anesthesiologist?

There is no such thing as "ER residency overlap". You've either done an EM residency, or you haven't. There is no shortcut, and there shouldn't be. Working 3 years in the ER with absolutely no oversight is not the same as the rigorous training we go through. When y'all do rotate with us, you are not held to the same standard as EM residents. Our FM colleagues that rotate through the ER are not seeing our sickest patients, they aren't carrying nearly as many patients as we do, they are not comfortable with procedures, oftentimes they are taking hour lunch breaks, leaving for conference, slowing everyone else around them down (which is to be expected). They do not have the hundreds of hours of lectures we have been apart of. Maybe you are one of the few exceptions that truly is an excellent clinician in the ER, but I have yet to see one of these exceptions. Even the non EM boarded attendings I have interacted with that have spent over a decade in our specialty are clearly deficient compared to their EM boarded counterparts.
 
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Unfortunately, ER residency is largely not an option after completing another residency because of Medicare funding.

I've had 5 yrs of ACGME residency in 3 specialties and currently in a fellowship...my training has significant ER residency overlap

That last paragraph shows indecisiveness in itself. Why would you change specialities 3 times(once I can understand)? I've also reviewed some previous posts and it appears your goal was to do EM via the FM route the majority of the time (with review of your 03/2014 posting) and maybe you had a change of heart later to do an EM residency but since you can't find a spot you want to do an unorthodox route.

I'll ask again, do you think it's appropriate to backdoor into EM? You never answered me directly?


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)Canada has the CCFP-EM certification
And that 1 year of EM after 2 of FM generally makes the CCFP-EM folks look undertrained, internationally. Also, the CCFP-EM people don't go work in the boonies, either.
Unfortunately, ER residency is largely not an option after completing another residency because of Medicare funding.

I've had 5 yrs of ACGME residency in 3 specialties and currently in a fellowship...
Unless you started out in some type of surgical residency, which would set your funding clock at 5 years, you're already into the IME time for funding, and to use the Medicare argument is specious. Alternately, what are the 3 specialties? That sounds rather indecisive.

And, I'll tell you - when I was a resident, there was an attending that had done med/peds, then worked a year in the ED. He then did EM residency, because that is what he felt he had to do to be the best EM doc he could be.
 
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My original specialty has 5 years of funding so nothing specious and my fellowship is not Medicare funded. Also, I'm not proposing an ABEM certificate, rather, an RFPEM from ABFM, which, to become feasible, would need some type of sponsorship from ABEM. Also, not here to be judged on my life choices and you have no right to label me as "indecisive"; I also did not attend an unorthodox residency or medical school :confused:. I'm not seeking to be called a "board-certified ER doctor"; an RFPEM would be meant for QA for non-ER doctors with ER skills in order to facilitate credentialing. Anyway, gonna end it here guys and will attempt a discussion somewhere less hostile.

And that 1 year of EM after 2 of FM generally makes the CCFP-EM folks look undertrained, internationally. Also, the CCFP-EM people don't go work in the boonies, either.

Unless you started out in some type of surgical residency, which would set your funding clock at 5 years, you're already into the IME time for funding, and to use the Medicare argument is specious. Alternately, what are the 3 specialties? That sounds rather indecisive.

And, I'll tell you - when I was a resident, there was an attending that had done med/peds, then worked a year in the ED. He then did EM residency, because that is what he felt he had to do to be the best EM doc he could be.
 
My original specialty has 5 years of funding so nothing specious and my fellowship is not Medicare funded. Also, I'm not proposing an ABEM certificate, rather, an RFPEM from ABFM, which, to become feasible, would need some type of sponsorship from ABEM. Also, not here to be judged on my life choices and you have no right to label me as "indecisive"; I also did not attend an unorthodox residency or medical school :confused:. I'm not seeking to be called a "board-certified ER doctor"; an RFPEM would be meant for QA for non-ER doctors with ER skills in order to facilitate credentialing. Anyway, gonna end it here guys and will attempt a discussion somewhere less hostile.

I can empathize with you and appreciate your situation to an extent -- you have a wish to do something and you want more education to do it. I applaud that.

In answer to your question:

Any ABEM-boarded guys here believe that non-ER residency trained docs should be able to attain a certification (not specialist/consultant-level certification but a competency-based certificate)?

No.

Sure, you can ask the question, but what sort of answers were you expecting from our group? We've all worked very hard to get where we are (just like I'm sure you worked hard to become an FP) and the premise of the question is 1) somewhat insulting and 2) has been asked eleventy million times before (just search our forum).

If you truly want to do EM, than, as many others have said, do an EM residency. This is not us being "snide." This is us sharing our opinion that you asked for. Your future patients will thank you for being well trained.

If you do decide to pursue this through the FP and EM boards, were you planning to recommend a similar option to allow EP's to get certification (competency-based) in family medicine so we can have an outpatient practice? We see a lot of primary care in the ED.
 
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Also, not here to be judged on my life choices and you have no right to label me as "indecisive"; I also did not attend an unorthodox residency or medical school :confused:.


Anyway, gonna end it here guys and will attempt a discussion somewhere less hostile.
Wow - overreact much? As stated above, what did you expect? And, logically, what would an external observer suspect after 3 residencies in 5 years?

So, since you use the SDN time-honored "hostile" label, well, good luck with your endeavors!
 
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3Q6zTyk.jpg
 
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Lol where do you guys get this stuff


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I may be a minority here, but I actually don't look down on non-EM residency trained docs. I just don't recommend it for people going forward. But as for IM or FP doctors who have worked in the ER for many long years, I can't reasonably look down on them. They are my colleagues, and some/many of them are damn good.

From a specialty and livelihood perspective, I think it's important to protect ourselves from non-EM boarded folks. But, this does not mean that non-EM boarded folks can't be just as good in reality.

And for a very long time to come there will be a need for these non-EM boarded folks to fill the need for EM doctors in understaffed and underserved facilities. I think in the end it works out for everyone. EM-boarded folks are blessed with having way more options, but even those non-EM folks (with ER experience) can find a place to work and fulfill a need.
 
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