Role for General Pediatrician in Rural ED?

[EarthtoneJon]

Hello,

I'm an incoming peds PGY1 in the northeast.

My question is for anyone who might know the answer, but especially for pediatricians practicing in rural communities: are general pediatricians ever contracted to staff EDs? I realize that, in urban EDs, there is usually a fellowship-trained peds ED doc, but what about in rural areas? From what I understand, the scarcity of pediatricians in rural areas may expand the pediatrician's role therein.

The reason I ask is that my last rotation of med school (once I had already matched) was in emergency medicine, and I absolutely loved it. I know that pediatrics is the right choice for me, because I do not want to treat adults, however, my heart hurts a little thinking about the ED. I plan to practice pediatrics in a rural area, and want to know if there will be opportunities to work ED shifts (for example, see patients 3 days per week + work 2 ED shifts) without going through 3 years of fellowship (especially since I want to practice mainly general peds). Can any rural pediatricians comment on their experiences / lack thereof working in the ED?

Thanks!

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[mvenus929]

You're probably not going to have volume enough in a rural ED to have a pediatrician working shifts. I have seen models where the pediatrician staffs the inpatient census, and is on call for the ED in case there are any peds questions the EM trained docs have.

 

[pedsisthebest333]

You're probably not going to have volume enough in a rural ED to have a pediatrician working shifts. I have seen models where the pediatrician staffs the inpatient census, and is on call for the ED in case there are any peds questions the EM trained docs have.

What about a general pediatrician, can they work in the fast track in the peds er?

 

[NurWollen]

Pretty sure there are general pediatricians working at almost every pediatric ED in the country, even in urban areas and even at teaching hospitals. For example, at one residency program where I interviewed, they hired general pediatricians to work in the ED and they did everything the peds-EM boarded people did except for trauma and directly supervising residents.

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[SurfingDoctor]

What about a general pediatrician, can they work in the fast track in the peds er?

Many places have general pediatricians in fast-track areas. Additionally, some institutions have pediatric after hours urgent cares (which is essentially the same thing). Occassionally, they will even in sick patients from either parents bringing rather sick kids to urgent care, or inappropriate triage in the ER. Generally speaking though, if a patient is actually sick, you need to move them out of fast-track or urgent care and quickly, but safely as possible.

 

[mvenus929]

What about a general pediatrician, can they work in the fast track in the peds er?

Absolutely, depending on the model of the ED. I will be working as such next academic year after I finish my residency. We do have some non-peds EM trained people staffing our main ED as well, but they've phased most of those people out in favor of fellowship trained people, and those who are still around will be retiring in the next couple years (they got grandfathered into the system). The only difference between them and the fellowship trained people was that they couldn't do sedation, and they couldn't staff traumas, but they still staffed cases with residents and took care of some sick patients.

 

[MEN2C]

We have two people in our ped who are peds. They are the only ones without a PEM fellowship and they were grandfathered in. No more of non fellowship trained people are hired. However, those two guys are amazing and see everything including trauma, major resuscitatations, sedation, etc

 

[NurWollen]

We have two people in our ped who are peds. They are the only ones without a PEM fellowship and they were grandfathered in. No more of non fellowship trained people are hired. However, those two guys are amazing and see everything including trauma, major resuscitatations, sedation, etc

Are you you at a big name academic institution? Community hospital? Somewhere in between?

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[MEN2C]

Are you you at a big name academic institution? Community hospital? Somewhere in between?

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Yeah big name academic center. I think one of our people is EM/PEM, the rest are PED/PEM, with the exception of the two who are grandfathered in (both have been there for 20+ years). I spoke to the head of the ED and they confirmed that if you're not PEM certified (through either EM or Pedi route), you wouldn't be considered for any position in the ED. We have a community hospital that's about 15 mins away that is run by general EM trained people, but they hired two PEM people last year for the peak times (after school 4pm-12am). I know they are looking to see if they can have a 24/7 Pedi area staffed only by PEM people, but obviously something like that will only make sense in very high volume EDs to make the staffing worthwhile.

 

[EarthtoneJon]

Thanks for the responses everyone. It sounds like non-fellowship-trained pediatricians do work in EDs, but are generally either grandfathered into the system, or are working in the fast track. I checked out the ED staff website for the children's hospital where I'll be starting residency, and there is only 1 non-fellowship-trained doc working in the ED.

This thread got me thinking about alternatives to working in the ED. The fast track section is one possibility. I have also been considering urgent care, which seems to be on the rise. Pros of working in an urgent care center, I would guess, include higher acuity than a normal day at the office (albeit lower acuity than the ED), shift work, opportunities for part time work, and not having to establish long-term relationships (if you consider that a pro). Cons might include irregular hours (urgent care opens in the evening when most offices close, and on weekends), no well visits / continuity (again, if you consider these to be "cons").

Any thoughts about the comparison between peds urgent care and peds ED?

 

[Dr. Wexler]

Any thoughts about the comparison between peds urgent care and peds ED?

Peds urgent care is a newer phenomenon vs. Peds ED (or PEM/Gen Peds working in a peds area of a general ED). Most Urgent Cares are open to all ages, and staffed by FPs, NPs, and PAs who see all comers, including adults. There are more and more pediatric urgent cares popping up in some areas, but this may vary from region to region.

Urgent cares at least have the perception of being more customer satisfaction oriented. "Make them happy or they'll pick the other urgent care down the block". So every pt gets: CXR, throat swab, Zpack. You also may end up doing sports physicals/school forms on kids you're meeting just one time in Urgent Care. That doesn't happen in the ED.

 

[mvenus929]

Peds urgent care is a newer phenomenon vs. Peds ED (or PEM/Gen Peds working in a peds area of a general ED). Most Urgent Cares are open to all ages, and staffed by FPs, NPs, and PAs who see all comers, including adults. There are more and more pediatric urgent cares popping up in some areas, but this may vary from region to region.

Urgent cares at least have the perception of being more customer satisfaction oriented. "Make them happy or they'll pick the other urgent care down the block". So every pt gets: CXR, throat swab, Zpack. You also may end up doing sports physicals/school forms on kids you're meeting just one time in Urgent Care. That doesn't happen in the ED.

This will depend entirely on the center. We now have 5 Peds urgent cares in our area (and all but one are busy all the time, and haven't pulled any traffic away from our ED). We don't do sports physicals at all there. Our providers are all pediatric trained (some NPs, mostly MDs), and follow a set of internal guidelines regarding testing, so most of it comes down to reassurance.

I know Texas Children's has a lot of Peds urgency cares opening (I kept getting recruitment emails for them), and I imagine other centers are looking into it.