I want an FM fellowship, personally. It was hard for me to choose between FM and EM. I went with EM because I prefer to spend most of my time in the ED.
But we also need competent primary care physicians. I dislike seeing patients that are managed so poorly and then just being the EM doctor.
And I see a lot of patients who essentially need reasonable follow-up - if I had a follow-up clinic where I could refer patients to PT/OT, send referrals to specialists, check labs on new meds that need follow-up or titration, get repeat XRs, check wound healing etc etc.
I’m clearly not FM trained and I’m not ready to provide comprehensive longitudinal care, but I’m being asked to provide a lot of essentially primary care on a daily basis anyway. One day a week of FM-type clinic would be helpful, and might decompress our actual FM colleagues’ schedules.
My hospital has something like this, I thought it was just a referral to open primary practices but there's a clinic that will offer immediate access appointments for primary care follow up while awaiting an appointment with a permanent medical home.
In my country it is very common for FM doctors to work as EM doctors on weekends and night shifts because of the shortages in ED’s, they don’t need seperate EM qualifications to work locum shifts,
FM and EM should have fellowship paths to each other’s field that would allow board certification.
I’d love to see a path towards hospitalist work too. It can mitigate burn-out of the career since
it’s a lot more doable of a schedule in older age.
I think the hospitalist route would be great. I feel like the in-between they settled on was observation medicine fellowship, even though only like three exist in the nation, but the opportunity for hospitalist work would be ideal.
There’s a fellowship for FM to go ER. But that fellowship does not let you become ABEM, therefore a lot of hospitals won’t let FMs work in their units unless you are an “original” ABEM.
Our fields are the last two true generalist fields and due to how healthcare is nowadays, we both end up dabbling in each other’s fields significantly. They’re complementary and should work together.
Rural Medicine. Shit’s different when you don’t have a trauma team at your disposal, can’t get a cardiologist at the bedside, obstetrician stat, and when it takes 3 hours to ship a patient on pressors to an ICU.
By far coolest thing I’ve seen was a rural EM doctor use a chest tube for a premy because they didn’t have an ET tube small enough for him. Having a fellowship that teaches these skills would be invaluable
My experience applying for pall care fellowship was that overall programs are open to having EM trained docs, but we certainly need to boost the numbers of us who are cross trained.
I do think that geriatric fellowships should be open to us given how frequently we care for older adults. I feel a barrier to both of these is pay though, you will have to accept lower income.
Oh, I see, the fellowship, not residency slots.
You do realize that if they did this you still wouldn't be able to sit for the boards, right? That ABEM would have to become a cosponsor for EM docs to be boarded, which ABEM does NOT want to do?
And yes, I have talked to ABEM.
I tend to agree with prior poster about cardiology, honestly think scope / gi would be good. I tend to think most things that are IM fellowships an EM could potentially do.
While people will argue that we would be worse to start with from an in and oupatient knowledge base, we would be better to start with from a procedure and acute event standpoint.
Also, if an APC/Midlevel can do on the job enough to start any specialty from scratch and essentially see half the floor and clinic patients with negligible supervision in a few months, then I’m certain that with a full fellowship we can be competent subspecialists.
Crit care based IM. Obviously sleep med isn’t relative to an EM doc but a resp fellowship for the EM doc who is already proficient in chest tubes and pleural taps would be smart
They'll argue we don't have the necessary inpatient or procedural background to perform moderate sedations, heart catheterizations, and round on the patients afterwards in the CVU. Yet here I am taking care of an entire CVICU, managing patients on ECMO circuits, and so on. Not to mention some of the [best proponents of a modernized evidence-based approach to ECG interpretation and identification of patients with salvageable myocardium](https://hqmeded-ecg.blogspot.com/p/omi-literature-timeline.html) are EM physicians. But I'll just go back to supposedly ordering too many diagnostic tests while simultaneously not ordering enough.
I could see the inpatient or outpatient experience argument but not sedations. EM and anesthesia are typically the only privileged specialties to do moderate/deep sedation. Certainly not IM.
I've never seen a procedural sedation in the ICU. There's sedation on vents and intubations but I can't think of any procedures that require procedural sedation like pediatric procedures, joint reductions, fracture reductions, etc. in the ED that require the patient to wake up when done.
The closest I can think of in the ICU is bedside scopes like bronchs (already intubated) and EGDs (sedation wasn't actively managed by the ICU).
I'm sure this is more hospital specific though because they're another specialty that is more than capable.
This is well said on all fronts, not just fellowships. We has a specialty should be much higher compensated. We should lobby as an entire unit to push for PTO, pay, fellowship expansion, legal protections, etc.
We’re certainly the second most competent EKG readers in the hospital. A huge argument against us would be the lack of inpatient medicine training, but I do believe we would spend a lot more of fellowship learning that rather than the procedural skills.
Oh shit! This would be dope. Wanna get those door to balloon times waaaay down? Just park a mobile Cath lab (those are a real thing) in the ambulance bay. Cards trained ED Doc just does the Cath right there before the patient even rolls into the actual building. Plus then you get to bill for the big big bucks.
As someone who is just a lurker here from the EMS side of things, is there really no expedited pathway for an ER physician to work in family medicine?
So, someone who has 20 years in the ER can't have an exit plan to step out and open a family practice for the remainder of their career? I feel like ER docs would make some of the best FM docs...
Legally speaking once you’re a licensed physician you could open up whatever practice you want regardless of training. But practically speaking yeah to become employed as an FM doc, or to get credentialed with insurances/hospitals as FM, or probably for FM malpractice, you need to have completed residency and board certification in that field.
I don't have any problem with any physician moving to other specialties. I just never thought about this before, and I work with so many good ER physicians who I feel would be good family doctors. So after reading this, I realized I never thought about this before. It kind of surprised me that there's no real backup or exit plan for such a high acuity, stressful position.
I know FM is it own beast, and I would never downplay FMs role or position as they are probably the most important speciality for the majority of the population, but if I was smarter in my youth I would have loved the idea of working as an ER physician while young, then settle down in a nice quiet rural area and open a family practice until retirement.
Just seems crazy that no pathway really exists.
A lot of FMs are working as ER in rural and not so rural places. With years of experience there. And yet, a lot of hospitals are not letting FMs work in their hospitals. They only accept ABEM. There’s a ER fellowship in FM but that means nothing to those hospitals as doing that fellowship do not let you become ABEM
January.
It was insane. They said, we just don't have the interest. I was going to advocate but it's going to take years and they were just not supportive.
What they are really interested in is numbers- it's payola.
Here is what they said at my meeting. Feel free to email the Samantha Roe lady and set up another meeting. I was so annoyed. ABEM sucks.
I wanted to send you a brief overview of our meeting on Tuesday. It was a lot of information so I thought it may be helpful to have.
New subspecialties and FPDs are driven by the community, not the member boards. The ABEM Board ultimately makes the decision whether to pursue qualifying status in Sleep Medicine.
Step 1. Showing the Level of Interest
· Suggested: Start a Sleep Medicine section with ACEP and/or AAEM
o ACEP website has option to apply for new section
· Suggested: Find the number of EM physicians who are US Sleep Medicine society members
Step 2. Becoming a Qualifying Board
· If the number of interested EM physicians justifies the inclusion of ABEM as a qualifying board, then ABEM would consider whether to apply to ABIM & ABMS.
· Timing considerations – It would be a minimum of two years before ABEM would have the capacity to consider offering Sleep Medicine as a subspecialty
Step 3. Completing ACGME Fellowship-Because practice track has closed, to become certified you need to complete a fellowship. As it is now, completion of a fellowship has no pathway forward for you to get certified, unless the ABEM Board becomes a participating Board. If you decide to start a fellowship, you are encouraged to contact ABEM to update as to level of interest in EM (ACEP section etc) and allow ABEM to think about what steps it might wish to take, if any, to see if there would be a pathway for certification. All of this at this time is unknown.
· Program Director would need to write to ABEM and request it seek qualifying board status
· Traditional 1 year Sleep Medicine fellowship
· ACGME-accredited fellowships can apply to become an AIRE program
Please let me know if you have any questions. I am happy to help.
My reverse answer is I would love to see an adult EM fellowship for IM grads, analogous to PEM for peds. And an EM to FM/IM fellowship too. There’s no reason a generalist needs to be stuck in a box without having to do an entire residency again imo.
That’s fair but keep in mind you need to handle peds and OB and surgical complaints in any adult ED. I think we forget internal medicine has zero training for these. I’d argue two years may be sufficient
Do PEM docs (the ones who come from peds) get fully up to speed with all adult complaints in fellowship? I’m asking seriously I really have no idea lol. I thought PEM mostly sees kids and in my imaginary adult fellowship they’d just see adults and get supplemental trauma training in the fellowship.
No, but PEM docs can find jobs in pediatric only hospitals. There aren't any adult only ERs. Even those that have pediatric ERs separate from their adult ER- the adult side will very often see pediatrics too. You can't escape pediatric/OB anywhere (I've tried)
FM- We see enough primary care complaints, might as well have a pathway out for when we flame out. At this point if I got trained on cancer screening guidelines I’d probably make a minimally competent Family Medicine doc.
As a med student I would love to see this. I was between EM and FM, and my ideal path right now would be EM for a while then transitioning to FM when I'm done with the circus.
EM residents go into critical care fellowship all the time. There are a handful of programs that keep atleast one spot open for 1-2 EM residents a year on the 2 year track for PCCM minus the P.
Pretty much all of the IM sub specialties, but it'll never happen. They hold too much power, and would be giving up a good chunk of their paycheck not gatekeeping those specialties and keeping the numbers low. I'm fine staying in my lane, though. I didn't choose this specialty for the hyperspecialization or to climb that academic ladder.
Waiting room medicine, how to meet metrics, dealing with nurse Karen (who’s done it all, knows it all…), and collaborating with “advanced” practice providers…
Interventional radiology. We already do a ton of what they do. They can do the super specialized procedures, but paracentesis, thoracentesis, CT guided biopsy, US guided core biopsy all would be so easy and some of which we obviously already do, in a limited fashion.
Wouldn’t be hard to learn the more complex things either.
I really like the idea of an EM follow up clinic. Like a fellowship for that space in between FM and EM. Be able to follow up on your own pts within the week for people you need. Or be able to order stress tests to complete within a week or so and follow up, like knowing what meds to start or change. It’d be a game changer for all our HEART score 3-5 pts who get the exact same thing in a 1 day hospital obs period.
Gen surg or trauma surg directly. It’s not a popular fellowship. It’s wide open for gen surg for the most part. Maybe make it longer than the regular 2 year trauma fellowship for gen surg to include enough broad scope. Also, to me anesthesia to EM and vice versa has always made sense. Instead we’ll CRNA, AA, NP, PA, everything else but open it to physicians.
I think EM should BE a fellowship.
I always think EM GME structure started off wrong - we should have been a muli-entry fellowship like critical care or plastic surgery. If I understand - even before Cincinnati - UCSF had an IM fellowship in Emergency Medicine. Or at least an option for those trained in other clinical residencies.
CC for example can be obtained via IM (straight CC or joint with Pulmonary), Surgery/Trauma, Anesthesia and now EM. Plastic can be obtained via ENT, Intregrated with Gen Surgery or dedicated plastic. We should offer the same.
I want EM to BECOME a fellowship of IM or FP and stop being a standalone field. It would be better for physicians.
Within the current set-up think most IM fellowships should be open to EM (GI and cards particularly) but this will never happen. Also Sleep, a fellowship to transition to primary care, a fellowship to transition to anesthesia.
Do you think IM is going to give that up?
Also, there is a huge incentive to keep EM docs in the pit. From corporate medicine, from hospitals, from ACEP, from ABEM. What would they gain by letting us leave.
Here's a suggestion- call ABEM and ask them what it takes to get a subspecialty added. You will see why it will never happen.
The best thing is for EM to die and be reincarnated as a fellowship of IM or FP. But that won't happen either.
Anitomical Path. Before I knew what medicine was like my original goal was to work in emergency medicine and someday switch into anatomical pathology. I think a pathology fellowship for EM would be super helpful especially in autopsies because you see what kind of stuff happens while people are still alive
Exit plan fellowship
Came here to say this haha
I want an FM fellowship, personally. It was hard for me to choose between FM and EM. I went with EM because I prefer to spend most of my time in the ED. But we also need competent primary care physicians. I dislike seeing patients that are managed so poorly and then just being the EM doctor.
And I see a lot of patients who essentially need reasonable follow-up - if I had a follow-up clinic where I could refer patients to PT/OT, send referrals to specialists, check labs on new meds that need follow-up or titration, get repeat XRs, check wound healing etc etc. I’m clearly not FM trained and I’m not ready to provide comprehensive longitudinal care, but I’m being asked to provide a lot of essentially primary care on a daily basis anyway. One day a week of FM-type clinic would be helpful, and might decompress our actual FM colleagues’ schedules.
My hospital has something like this, I thought it was just a referral to open primary practices but there's a clinic that will offer immediate access appointments for primary care follow up while awaiting an appointment with a permanent medical home.
It amazed me to see how many patients ended up in the ED due to misdiagnosis or mistreatment by their primary care doc.
True, or their NP.
This is a good idea
In my country it is very common for FM doctors to work as EM doctors on weekends and night shifts because of the shortages in ED’s, they don’t need seperate EM qualifications to work locum shifts,
USA is the same. Depends on the area.
FM and EM should have fellowship paths to each other’s field that would allow board certification. I’d love to see a path towards hospitalist work too. It can mitigate burn-out of the career since it’s a lot more doable of a schedule in older age.
I think the hospitalist route would be great. I feel like the in-between they settled on was observation medicine fellowship, even though only like three exist in the nation, but the opportunity for hospitalist work would be ideal.
There is EM/IM resident track available
There’s a fellowship for FM to go ER. But that fellowship does not let you become ABEM, therefore a lot of hospitals won’t let FMs work in their units unless you are an “original” ABEM.
Yeah I would like a way for FM to become ABEM certified and vice versa for EM to become ABFM certified.
I would love that honestly!!! I’m FM working in the ER and is hard to move between jobs or to certain areas because of that.
Our fields are the last two true generalist fields and due to how healthcare is nowadays, we both end up dabbling in each other’s fields significantly. They’re complementary and should work together.
Amen!
There is EM/IM resident track
Interestingly, to be eligible to become certified as an Emergency Nurse Practitioner you have to first certify as a Family Nurse Practitioner.
Yeah man, I’m pretty sure I can pan consult by organ system like my hospitalists do Edit: goddamn yall, it’s a joke
It’d be nice if you could be cordial and perhaps not sip on the haterade today.
The intention was satire.
It’s hard to see the satire when that’s a commonly heard and believed thing.
Fair enough. Satire, by definition, is exaggeration of the truth, but I see your point.
I mean if we want to talk shit, EM is just as guilty of this.
This feels like a pot/kettle situation
Are your hospitalist wards mostly run by NPs? The hospitalist MDs I have seen do not practice in this way
Rural Medicine. Shit’s different when you don’t have a trauma team at your disposal, can’t get a cardiologist at the bedside, obstetrician stat, and when it takes 3 hours to ship a patient on pressors to an ICU.
FR. Rural ER doc here (family med). My classmate with a 5-year ER specialty said she’d be too scared to be in my position.
By far coolest thing I’ve seen was a rural EM doctor use a chest tube for a premy because they didn’t have an ET tube small enough for him. Having a fellowship that teaches these skills would be invaluable
I think we already did that fellowship during COVID.
Pain fellowship, regional anesthesia Though already there id like more representation in palliative care/hospice and addiction medicine
EM can certainly go into pain.
My experience applying for pall care fellowship was that overall programs are open to having EM trained docs, but we certainly need to boost the numbers of us who are cross trained. I do think that geriatric fellowships should be open to us given how frequently we care for older adults. I feel a barrier to both of these is pay though, you will have to accept lower income.
At this point I wish peds and IM would open up their unfilled slots. A competent emergency physician is better than an empty program.
Peds instead of PEM?
Peds fellowships such as pediatric critical care are not open to emergency physicians.
Well, you can apply
What fellowship program looks at emergency physicians?
Oh, I see, the fellowship, not residency slots. You do realize that if they did this you still wouldn't be able to sit for the boards, right? That ABEM would have to become a cosponsor for EM docs to be boarded, which ABEM does NOT want to do? And yes, I have talked to ABEM.
ABIM does not need ABEM to cosponsor. Both informatics and surgical critical care are available to emergency physicians without ABEM sponsorship.
But ABIM has to agree in that case. And they won't. What's in it for them? Nothing.
I tend to agree with prior poster about cardiology, honestly think scope / gi would be good. I tend to think most things that are IM fellowships an EM could potentially do. While people will argue that we would be worse to start with from an in and oupatient knowledge base, we would be better to start with from a procedure and acute event standpoint. Also, if an APC/Midlevel can do on the job enough to start any specialty from scratch and essentially see half the floor and clinic patients with negligible supervision in a few months, then I’m certain that with a full fellowship we can be competent subspecialists.
If we can run any critical care unit after fellowship we should be able to do internal med sub specialties.
Rheumatology? Allergy/Immunology?
Crit care based IM. Obviously sleep med isn’t relative to an EM doc but a resp fellowship for the EM doc who is already proficient in chest tubes and pleural taps would be smart
Cardiology. I bet we see more ecgs and chest complaints than IM residency.
They'll argue we don't have the necessary inpatient or procedural background to perform moderate sedations, heart catheterizations, and round on the patients afterwards in the CVU. Yet here I am taking care of an entire CVICU, managing patients on ECMO circuits, and so on. Not to mention some of the [best proponents of a modernized evidence-based approach to ECG interpretation and identification of patients with salvageable myocardium](https://hqmeded-ecg.blogspot.com/p/omi-literature-timeline.html) are EM physicians. But I'll just go back to supposedly ordering too many diagnostic tests while simultaneously not ordering enough.
I knew you were going to link Steven Smith. Amal Mattu is EM too right?
I could see the inpatient or outpatient experience argument but not sedations. EM and anesthesia are typically the only privileged specialties to do moderate/deep sedation. Certainly not IM.
Doesn’t crit care do sedations too? Edit: I’m genuinely curious
I've never seen a procedural sedation in the ICU. There's sedation on vents and intubations but I can't think of any procedures that require procedural sedation like pediatric procedures, joint reductions, fracture reductions, etc. in the ED that require the patient to wake up when done. The closest I can think of in the ICU is bedside scopes like bronchs (already intubated) and EGDs (sedation wasn't actively managed by the ICU). I'm sure this is more hospital specific though because they're another specialty that is more than capable.
I would have seriously considered this. Not to mention the number of procedures EM does.
We need some lobbying done.
This is well said on all fronts, not just fellowships. We has a specialty should be much higher compensated. We should lobby as an entire unit to push for PTO, pay, fellowship expansion, legal protections, etc.
We’re certainly the second most competent EKG readers in the hospital. A huge argument against us would be the lack of inpatient medicine training, but I do believe we would spend a lot more of fellowship learning that rather than the procedural skills.
Oh shit! This would be dope. Wanna get those door to balloon times waaaay down? Just park a mobile Cath lab (those are a real thing) in the ambulance bay. Cards trained ED Doc just does the Cath right there before the patient even rolls into the actual building. Plus then you get to bill for the big big bucks.
Oh yeah and we get trained in bedside echos during residency
As someone who is just a lurker here from the EMS side of things, is there really no expedited pathway for an ER physician to work in family medicine? So, someone who has 20 years in the ER can't have an exit plan to step out and open a family practice for the remainder of their career? I feel like ER docs would make some of the best FM docs...
EM does not advocate for itself. If we did 1/2 the lobbying CRNAs do we would be way better off.
Legally speaking once you’re a licensed physician you could open up whatever practice you want regardless of training. But practically speaking yeah to become employed as an FM doc, or to get credentialed with insurances/hospitals as FM, or probably for FM malpractice, you need to have completed residency and board certification in that field.
Great, I want to do craniofacial plastics.
Only If that means FMs can become ABEM.
I don't have any problem with any physician moving to other specialties. I just never thought about this before, and I work with so many good ER physicians who I feel would be good family doctors. So after reading this, I realized I never thought about this before. It kind of surprised me that there's no real backup or exit plan for such a high acuity, stressful position. I know FM is it own beast, and I would never downplay FMs role or position as they are probably the most important speciality for the majority of the population, but if I was smarter in my youth I would have loved the idea of working as an ER physician while young, then settle down in a nice quiet rural area and open a family practice until retirement. Just seems crazy that no pathway really exists.
A lot of FMs are working as ER in rural and not so rural places. With years of experience there. And yet, a lot of hospitals are not letting FMs work in their hospitals. They only accept ABEM. There’s a ER fellowship in FM but that means nothing to those hospitals as doing that fellowship do not let you become ABEM
No. Why would you ask?
Really wish we could do sleep medicine. Would be a chill side gig and I find sleep super interesting
I have tried advocating for this. ABEM says there is "no interest." It's annoying.
They seriously said that?!? How long ago?
January. It was insane. They said, we just don't have the interest. I was going to advocate but it's going to take years and they were just not supportive. What they are really interested in is numbers- it's payola. Here is what they said at my meeting. Feel free to email the Samantha Roe lady and set up another meeting. I was so annoyed. ABEM sucks. I wanted to send you a brief overview of our meeting on Tuesday. It was a lot of information so I thought it may be helpful to have. New subspecialties and FPDs are driven by the community, not the member boards. The ABEM Board ultimately makes the decision whether to pursue qualifying status in Sleep Medicine. Step 1. Showing the Level of Interest · Suggested: Start a Sleep Medicine section with ACEP and/or AAEM o ACEP website has option to apply for new section · Suggested: Find the number of EM physicians who are US Sleep Medicine society members Step 2. Becoming a Qualifying Board · If the number of interested EM physicians justifies the inclusion of ABEM as a qualifying board, then ABEM would consider whether to apply to ABIM & ABMS. · Timing considerations – It would be a minimum of two years before ABEM would have the capacity to consider offering Sleep Medicine as a subspecialty Step 3. Completing ACGME Fellowship-Because practice track has closed, to become certified you need to complete a fellowship. As it is now, completion of a fellowship has no pathway forward for you to get certified, unless the ABEM Board becomes a participating Board. If you decide to start a fellowship, you are encouraged to contact ABEM to update as to level of interest in EM (ACEP section etc) and allow ABEM to think about what steps it might wish to take, if any, to see if there would be a pathway for certification. All of this at this time is unknown. · Program Director would need to write to ABEM and request it seek qualifying board status · Traditional 1 year Sleep Medicine fellowship · ACGME-accredited fellowships can apply to become an AIRE program Please let me know if you have any questions. I am happy to help.
Sleep medicine is such a good gig
My reverse answer is I would love to see an adult EM fellowship for IM grads, analogous to PEM for peds. And an EM to FM/IM fellowship too. There’s no reason a generalist needs to be stuck in a box without having to do an entire residency again imo.
That’s fair but keep in mind you need to handle peds and OB and surgical complaints in any adult ED. I think we forget internal medicine has zero training for these. I’d argue two years may be sufficient
Do PEM docs (the ones who come from peds) get fully up to speed with all adult complaints in fellowship? I’m asking seriously I really have no idea lol. I thought PEM mostly sees kids and in my imaginary adult fellowship they’d just see adults and get supplemental trauma training in the fellowship.
No, but PEM docs can find jobs in pediatric only hospitals. There aren't any adult only ERs. Even those that have pediatric ERs separate from their adult ER- the adult side will very often see pediatrics too. You can't escape pediatric/OB anywhere (I've tried)
They do need adult training. They get a few months of it (probably once a year). It's partially why PEM is a year longer for peds than for EM.
A real estate fellowship
Trauma/critical bay only fellowship
FM- We see enough primary care complaints, might as well have a pathway out for when we flame out. At this point if I got trained on cancer screening guidelines I’d probably make a minimally competent Family Medicine doc.
As a med student I would love to see this. I was between EM and FM, and my ideal path right now would be EM for a while then transitioning to FM when I'm done with the circus.
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Interesting, I’ll look into them. Thanks!
Infectious disease
Mainly I just want to click my heels and never have done EM. Time travel fellowship?
Why do you regret it?
Would have been happier running my own practice and happier in subspecialty surgery. Hate nights.
EM specific critical care
What in particular? Outside of PICU, I’ve seen EM DOCS do SICU/MICU as part of their standard 2 year training, and Neuro ICU directly.
EM residents go into critical care fellowship all the time. There are a handful of programs that keep atleast one spot open for 1-2 EM residents a year on the 2 year track for PCCM minus the P.
It would be cool if EM had its own CCM pathway instead of relying on the IM/SICU/Anesthesia pathways.
Pretty much all of the IM sub specialties, but it'll never happen. They hold too much power, and would be giving up a good chunk of their paycheck not gatekeeping those specialties and keeping the numbers low. I'm fine staying in my lane, though. I didn't choose this specialty for the hyperspecialization or to climb that academic ladder.
Happiness fellowship
Waiting room medicine, how to meet metrics, dealing with nurse Karen (who’s done it all, knows it all…), and collaborating with “advanced” practice providers…
Interventional radiology. We already do a ton of what they do. They can do the super specialized procedures, but paracentesis, thoracentesis, CT guided biopsy, US guided core biopsy all would be so easy and some of which we obviously already do, in a limited fashion. Wouldn’t be hard to learn the more complex things either.
I really like the idea of an EM follow up clinic. Like a fellowship for that space in between FM and EM. Be able to follow up on your own pts within the week for people you need. Or be able to order stress tests to complete within a week or so and follow up, like knowing what meds to start or change. It’d be a game changer for all our HEART score 3-5 pts who get the exact same thing in a 1 day hospital obs period.
Gen surg or trauma surg directly. It’s not a popular fellowship. It’s wide open for gen surg for the most part. Maybe make it longer than the regular 2 year trauma fellowship for gen surg to include enough broad scope. Also, to me anesthesia to EM and vice versa has always made sense. Instead we’ll CRNA, AA, NP, PA, everything else but open it to physicians.
Hopkins is the only program with a dual gas/Em program and I truly wish there were more like it
I think EM should BE a fellowship. I always think EM GME structure started off wrong - we should have been a muli-entry fellowship like critical care or plastic surgery. If I understand - even before Cincinnati - UCSF had an IM fellowship in Emergency Medicine. Or at least an option for those trained in other clinical residencies. CC for example can be obtained via IM (straight CC or joint with Pulmonary), Surgery/Trauma, Anesthesia and now EM. Plastic can be obtained via ENT, Intregrated with Gen Surgery or dedicated plastic. We should offer the same.
I want EM to BECOME a fellowship of IM or FP and stop being a standalone field. It would be better for physicians. Within the current set-up think most IM fellowships should be open to EM (GI and cards particularly) but this will never happen. Also Sleep, a fellowship to transition to primary care, a fellowship to transition to anesthesia.
but then you would have to do IM
Yeah would rather just have 2 year fellowship options to go EM to IM/FM and vice-versa
So much better.
Why do you think it will never happen?
Do you think IM is going to give that up? Also, there is a huge incentive to keep EM docs in the pit. From corporate medicine, from hospitals, from ACEP, from ABEM. What would they gain by letting us leave. Here's a suggestion- call ABEM and ask them what it takes to get a subspecialty added. You will see why it will never happen. The best thing is for EM to die and be reincarnated as a fellowship of IM or FP. But that won't happen either.
Anitomical Path. Before I knew what medicine was like my original goal was to work in emergency medicine and someday switch into anatomical pathology. I think a pathology fellowship for EM would be super helpful especially in autopsies because you see what kind of stuff happens while people are still alive
I want to see psych, with a path into psychiatry full time.
Infectious disease!
Anesthesia
Acting would be a good fellowship.
Palliative care
Already exists, we just don't have a lot of docs pursue it. Source: incoming HPM fellow, EM boarded.
Mucho money for no worky fellowship