PEM

[DrWhozits]

Does anyone here practice a split between EM at a normal hospital, and then PEM at a children's hospital?

I was wondering if anybody has done this to try and to ease some of the burnout from drug-seekers, psych patients, etc.

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[onlyletters]

Does anyone here practice a split between EM at a normal hospital, and then PEM at a children's hospital?

I was wondering if anybody has done this to try and to ease some of the burnout from drug-seekers, psych patients, etc.

Yea, a couple of PEM trained attendings at my program do that.

 

[carbonizedeyesockets]

As a med student I worked with a doc who split her time between a "regular" ED and a peds ED. Both EDs were non-academic aside from the ped ED hosting medical students.

 

[BoardingDoc]

Does anyone here practice a split between EM at a normal hospital, and then PEM at a children's hospital?

I was wondering if anybody has done this to try and to ease some of the burnout from drug-seekers, psych patients, etc.

Yeah. That can be done. One of my former attendings is now doing a roughly 50/50 split between regular and pedi EDs.

 

[DeadCactus]

The fairly obvious caveat being you need to do an EM residency and PEM fellowship or the combined EM/Peds residency (though some pediatric ED's may not be open to hiring a combined graduate). The Peds + PEM route won't allow for this.

 

[WilcoWorld]

I was wondering if anybody has done this to try and to ease some of the burnout from drug-seekers, psych patients, etc.

Sorry, but they show up to Peds ED's as well. Often as parents, sometimes as patients.

 

[SamtheWise]

yes, you have to do a residency in emergency medicine and not pediatrics, but people do it all the time. Most people who do it are EM trained plus a PEM fellowship, but there's some pediatric EDs that allow regular emergency docs (without a PEM fellowship) to work there.

But remember, you may have less psych patients and drug seekers, but you have exponentially more non accidental trauma. One PEM doc I heard give a lecture averages about one reportable incident per shift, I dunno how generalizable that is, but that seems like a lot.

 

[DrWhozits]

yes, you have to do a residency in emergency medicine and not pediatrics, but people do it all the time. Most people who do it are EM trained plus a PEM fellowship, but there's some pediatric EDs that allow regular emergency docs (without a PEM fellowship) to work there.

But remember, you may have less psych patients and drug seekers, but you have exponentially more non accidental trauma. One PEM doc I heard give a lecture averages about one reportable incident per shift, I dunno how generalizable that is, but that seems like a lot.

This is true. I didn't think about that really. But regardless, it might be just a nice change of pace, but I'm not sure it's worth the 2-yr fellowship. I was curious more than anything.

 

[Greenbbs]

I do roughly a 70/30 split between my hospital's adult and Peds ed. EM trained, not PEM. Helps a ton with the day to day bull****

 

[DrWhozits]

I do roughly a 70/30 split between my hospital's adult and Peds ed. EM trained, not PEM. Helps a ton with the day to day bull****

This is what I was wanting to know. How difficult was it to find a setup like this? Are you full-time EM, part-time Peds, or is it just one job that allows you do a split?

 

[Greenbbs]

This is what I was wanting to know. How difficult was it to find a setup like this? Are you full-time EM, part-time Peds, or is it just one job that allows you do a split?

I'm full time EM. My place has an adult and Peds ED. I originally didn't set out to do this, but really like the change in pace the Peds ED offers.

I do enough Peds where I can be the sole doc in the place but if you don't do a lot of Peds, you end up being the second attending in the evening.

It's single covered overnight (12a-8a), day shift (8a-4p), then double covered from 4p-12a). APP coverage from 8a-6p, 10a-8p, and 3p-1a. 3 resident shifts as well (FP and Peds residents from U of Rochester).

I guess it just varies on what each individual location's policies are. I'm not sure how common a setup like this is

 

[deleted109597]

The fairly obvious caveat being you need to do an EM residency and PEM fellowship or the combined EM/Peds residency (though some pediatric ED's may not be open to hiring a combined graduate). The Peds + PEM route won't allow for this.

Or you could just do EM. Plenty of shops don't require PEM if they aren't training fellows. Sure, they might prefer them, but they'll often take you if you have experience.

 

[deleted109597]

This is what I was wanting to know. How difficult was it to find a setup like this? Are you full-time EM, part-time Peds, or is it just one job that allows you do a split?

I simply asked the peds shop in my town if I could.
They had needs, and were willing to let me do it part time.

 

[KaapstadMK]

How many of y'all did Peds/EM vs PEM?

 

[deleted109597]

How many of y'all did Peds/EM vs PEM?

Neither. I'm EM. 20% of our boards is peds.

 

[DeadCactus]

There are 9 people a year graduating from a combined EM/Peds program. PEM fellowship (or no fellowship) are far more common. You can do PEM without a fellowship but that's like saying you can do EM through family medicine. The jobs exist but the market will be comparatively limited. If it's just a side gig that could be fun but isn't a make or break for your career, then forgo the additional training. If it's the focus of your career than get the additional training.

 

[deleted109597]

There are 9 people a year graduating from a combined EM/Peds program. PEM fellowship (or no fellowship) are far more common. You can do PEM without a fellowship but that's like saying you can do EM through family medicine. The jobs exist but the market will be comparatively limited. If it's just a side gig that could be fun but isn't a make or break for your career, then forgo the additional training. If it's the focus of your career than get the additional training.

If you work solely at a peds shop, it makes sense. But if you don't, and you argue you shouldn't work at one without fellowship, then you should also argue that you shouldn't see kids at your main shop.

 

[DeadCactus]

My argument isn't that you shouldn't work at a pediatric ED without additional training. My argument is that your ability to work at a PED without additional training is driven by the availability of people with additional training in that market. If PEM is a major goal in your life, then you should pursue the training to maximize your opportunities. This is the same argument we present to those wanting to do EM from FM. If your goal is full-time EM, then train in EM even if it requires a second residcency. If it's something you're OK doing on the side and/in less desirable areas then FM is reasonable.

The arguments about who should do what in medicine are asinine. The reality is that scope of practice is driven by the market and brand strength, not board certification.

 

[deleted109597]

From an opportunity standpoint I agree with you.

 

[Perrotfish]

If you work solely at a peds shop, it makes sense. But if you don't, and you argue you shouldn't work at one without fellowship, then you should also argue that you shouldn't see kids at your main shop.

I'm gonna disagree. Kids in the community =/= kids in a Peds ED. If you are working in a Pediatric Emergency Room odds are your hospital is making a deliberate effort to attract higher acuity Pediatric patients, likely with an attached cardiology and heme onc service at a bare minimum. There is a huge difference between a community ED doctor acknowledging that he will do his best with whatever walks through the door for the rare complicated kid, and a non-Peds EM doc seeking out an ED that sees multiple Peds onc, congenital heart, and metabolic kids a week despite not having more than a bare minimum of training in those conditions.

 

[deleted109597]

I'm gonna disagree. Kids in the community =/= kids in a Peds ED. If you are working in a Pediatric Emergency Room odds are your hospital is making a deliberate effort to attract higher acuity Pediatric patients, likely with an attached cardiology and heme onc service at a bare minimum. There is a huge difference between a community ED doctor acknowledging that he will do his best with whatever walks through the door for the rare complicated kid, and a non-Peds EM doc seeking out an ED that sees multiple Peds onc, congenital heart, and metabolic kids a week despite not having more than a bare minimum of training in those conditions.

You can disagree all you want. But this is the same as the argument about having ABEM guys at the tertiary centers, and FM guys in the sticks. At the tertiary shop, I've got those guys around to call and ask for help. In the sticks, not so much.
Also, if you do EM/PEM, then you still don't get a lot of that in fellowship. And you get even less with regards to procedures. It's just the nature of the PEM fellowship training.