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magneto

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Thank you for offering to do this!

As a medical student with interest in doing 2+1 in EM, I have a couple of questions: 

1) How do you want to shape your practice with the 2+1 in EM training? (i.e. weekly schedule, where you would like to practice FM & EM in terms of urban / suburban / rural settings...etc.) 

2) How competitive is 2+1 EM? What is the advantage of getting 2+1 EM training vs. just doing 2 years of family med residency in terms of job outlook for EM positions? 

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On 2/6/2020 at 7:08 PM, TILs said:

1) How do you want to shape your practice with the 2+1 in EM training? (i.e. weekly schedule, where you would like to practice FM & EM in terms of urban / suburban / rural settings...etc.)

After finishing EM residency, my plan is to initially work mostly in ED in a mid-size city.

From my limited personal experience, most recent CCFP-EM (2+1) grads are choosing to practice in only ED in urban/suburban settings. Very few would go to rural settings.

However, there are many CCFP-EM grads who practice both FM and EM and you can find them in any setting (urban/suburban/rural).

Where would you like to practice? Do you want to do both FM and EM?

In my opinion, I think family medicine residency alone with rotations/electives in EM/ICU/Trauma and hard work is enough to be a competent doctor in a rural setting. I don't think 2+1 is needed (just my opinion).

Again, in my opinion, most CCFP-EM residency programs are very strong and prepare their residents to work in any center in Canada (Tertiary care, Trauma centers, Urban vs Suburban vs Rural etc.). Therefore, most graduates end up working in mid-size (if not large hospitals). However, jobs are not super easy for 2+1 grads at very big academic hospitals but the probability is not zero.

Let me know if I answered your question.

 

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On 2/6/2020 at 7:08 PM, TILs said:

2) How competitive is 2+1 EM? What is the advantage of getting 2+1 EM training vs. just doing 2 years of family med residency in terms of job outlook for EM positions? 

2+1 EM is very (if not extremely) competitive. There are many reasons for this. Some of them are: (1) EM is becoming more and more popular each year for medical students. (2) Many medical students who apply to 5-year EM program, also apply to FM as a back-up. These applicants already have a strong EM application and now they have another year to make the application even stronger. (3) Many medical students go to FM with good intentions but for many reasons find out that FM is not for them. 2+1 EM options allows them to choose a similar but alternative career.

Finding a job in ED of your choice is the easiest when you are the graduate of 5-year royal college EM residency. It is hardest when you only have 2-year FM residency. That means, 2+1 fits in the middle. Therefore, if you want to work in ED, definitely apply for either 5-year residency or go for 2+1 option.

Just a few years ago, many community hospitals would let FM only physicians to pick up shifts in the ED. Some even hired FM only physicians. However, it is getting difficult. One of the community hospitals that I was considering to work in use to hire FM only physicians but they have now change their policy and now require at least 2+1.

So in summary, 2+1 is very competitive. If you want to work in ED in mid-size city/large city, definitely either do 5-year royal college residency or 2+1. For rural hospitals and remote settings, 2 years of FM is enough to work in ED as long as you had good exposure to trauma/ICU/EM during your FM residency.

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On 2/7/2020 at 8:06 PM, magneto said:

2+1 EM is very (if not extremely) competitive. There are many reasons for this. Some of them are: (1) EM is becoming more and more popular each year for medical students. (2) Many medical students who apply to 5-year EM program, also apply to FM as a back-up. These applicants already have a strong EM application and now they have another year to make the application even stronger. (3) Many medical students go to FM with good intentions but for many reasons find out that FM is not for them. 2+1 EM options allows them to choose a similar but alternative career.

Finding a job in ED of your choice is the easiest when you are the graduate of 5-year royal college EM residency. It is hardest when you only have 2-year FM residency. That means, 2+1 fits in the middle. Therefore, if you want to work in ED, definitely apply for either 5-year residency or go for 2+1 option.

Just a few years ago, many community hospitals would let FM only physicians to pick up shifts in the ED. Some even hired FM only physicians. However, it is getting difficult. One of the community hospitals that I was considering to work in use to hire FM only physicians but they have now change their policy and now require at least 2+1.

So in summary, 2+1 is very competitive. If you want to work in ED in mid-size city/large city, definitely either do 5-year royal college residency or 2+1. For rural hospitals and remote settings, 2 years of FM is enough to work in ED as long as you had good exposure to trauma/ICU/EM during your FM residency.

Thank you so much! This was so helpful. 

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On 2/6/2020 at 8:48 PM, magneto said:

I am currently doing emergency medicine residency (2+1 pathway to EM) and would like to help forum members by answering any questions about emergency medicine residency (FR or 2+1) and emergency medicine as a career.

Thank you for doing this. Sometimes people say that family doctors can bill using specialist codes e.g for family doctors working in EM or hospital medicine. Is this true? It doesn't make sense to me that the government would be pay both the same. 

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On 2/19/2020 at 3:36 PM, Fortress said:

Thank you for doing this. Sometimes people say that family doctors can bill using specialist codes e.g for family doctors working in EM or hospital medicine. Is this true? It doesn't make sense to me that the government would be pay both the same. 

Pasting from my other thread.

As far as I know family doctors have their own codes for pretty much everything.

I did my own billing as a resident.

There were family medicine codes for everything from standard visit to procedures to OB to palliative care to hospitalist etc.

The only specialty that have similar codes/pay between family doctors and specialists is emergency medicine where 2+1 grads and 5 year FR grads have similar pay (but only in some provinces not all).

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On 2/19/2020 at 4:35 PM, Windcalibur said:

Can you comment on how to be competitive for the 2+1 program? Specifically are rural sites better than urban sites? Are there FM programs that have a good track record for the 2+1 EM?

Thanks!

There is no magic formula.

2+1 program was already competitive but over the last few years it has become more competitive.

I think one of the reason is that 5-year FR EM program is becoming more popular each graduating year. And medical students are becoming more strategic from day 1. So most students who are interested in 5-year FR EM program often back up with FM programs.

Here is my take on it:

1. Try to decide soon (rather than late) in your FM residency whether you will apply for 2+1 EM.

2. Arrange as many electives as you can in places where you want to match.

3. Before your electives, have a good understanding about EM.

4. Do basics like BLS, ACLS, ATLS etc.

5. Know a few things about airway management. Watch youtube videos.

6. Know a few things about MSK injuries and casting. Watch youtube videos. High yield items are shoulder reductions and distal radius fractures.

7. Memorize ABCDE. The answer is always ABCDE :)

8. Find a mentor in EM. Possibly someone who wants to be a mentor rather than being forced into the position.

9. Be confident but not arrogant.

10. Don't annoy others.

11. Don't be a gunner.

The most important thing to match to the program are: (A) reference letters and (B) performance at the elective.

Most programs will only interview if you have done an elective there. E.g., includes UofT, UBC, Western etc.

Some programs will interview strong candidates without doing an elective. E.g., includes UofA, UofC, UofS etc.

Some programs may not interview you even after doing a strong elective. E.g., UofT.

Once again, there is no magic formula. Be genuine. Work hard. Try to know your stuff. When you don't know - say so - and take the opportunity to learn. Don't be arrogant. Don't be a gunner. Don't annoy others (it is a fine balance between being keen vs annoying).

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Thanks for doing this @magneto. How does the earning potential of EM compare with FM generally speaking? I know FMs can make quite a bit doing stuff like pain clinics for instance. While I'm asking, how does it compare to the earning potential as an FM-hospitalist? I know it's really hard to quote numbers, but even rough estimates would be really helpful :)

Thanks!!

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On 2/27/2020 at 5:54 PM, PeterPatting said:

Thanks for doing this @magneto. How does the earning potential of EM compare with FM generally speaking? I know FMs can make quite a bit doing stuff like pain clinics for instance. While I'm asking, how does it compare to the earning potential as an FM-hospitalist? I know it's really hard to quote numbers, but even rough estimates would be really helpful :)

Thanks!!

I'll add to this question. Let's assume high efficient outpatient doc vs EM doc capable of doing above average shifts vs hospitalist in a good higher earning pay model. 

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On 2/6/2020 at 5:48 PM, magneto said:

I am currently doing emergency medicine residency (2+1 pathway to EM) and would like to help forum members by answering any questions about emergency medicine residency (FR or 2+1) and emergency medicine as a career.

Magneto, good idea starting this thread. I’m happy to check back here and answer questions as well. I’m FRCPC trained so can provide insight into that or anything EM related. 

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What practice scope do prehospital doctors have in Canada? I have not been able to find much on this. From what I have researched Canadian prehospital medicine seems more administrative in nature. Whereas in Australia where I am based prehospital and retrieval medicine mirrors the British model where doctors will frequently act as first responders and escort very ill patients from facility to facility. In Canada it seems that advanced care paramedics take on this role. Or do Canadian prehospital fellowships allow EM doctors to do this? I am thinking about applying for prehospital fellowships but I am not sure if I should apply in Canada especially if the role is more administrative as opposed to clinical. 

Many thanks for starting this thread.

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Can you tell me what you love most and what you like least about EM?

I am drawn to EM because of the challenging and fast paced nature of the job. I love being on my feet and not knowing what's coming next, and that I would be the first line of care when people need help. But I have also heard that there is a lot of handover to and reliance on specialists as you wouldn't be an expert on any specific area. I have also heard patient interaction and relationships are minimal. Just what I have heard though. I could be very wrong about my perception of the field, so your thoughts are very appreciated!

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12 hours ago, RiderSx said:

Can you tell me what you love most and what you like least about EM?

I am drawn to EM because of the challenging and fast paced nature of the job. I love being on my feet and not knowing what's coming next, and that I would be the first line of care when people need help. But I have also heard that there is a lot of handover to and reliance on specialists as you wouldn't be an expert on any specific area. I have also heard patient interaction and relationships are minimal. Just what I have heard though. I could be very wrong about my perception of the field, so your thoughts are very appreciated!

When I applied to CaRMS I knew I didn’t want any surgical speciality. Initially at the start of clerkship I was drawn to surgery but quickly learned the lifestyle and me didn’t mix. A big thing I learned during medical school about myself was that I enjoyed medicine, life long learning, the intellectual and social aspects of the field. But I could not be happy if medicine occupied the majority of my time. I simply had too many other interests that I enjoyed to give up more than 50% of my time to medicine. 

During my ward based rotations I also learned that these jobs would crush my soul. I just found the environment depressing, bureaucratic, and inefficient. To be frank, I just found it terribly boring. 

I still liked procedure based medicine, one of the things that drew me to surgery initially. For me, I also had zero interest in longitudinal care, but I really enjoyed the mystery solving aspect of medicine, and talking to various people, and getting undifferentiated cases on their way to being resolved. That was deeply rewarding, more so than the longitudinal care aspects of medicine. That’s how it was for me. 

Once I realized these things, I saw that there was few fields that were action oriented, quick paced, diagnostic in nature, involved direct patient care, had procedures, and avoided hospital wards. This pretty much only left emergency medicine. By the time CaRMS came around I couldn’t imagine doing anything else and enjoying a life in medicine as much as I could. The certainty on this realization was why I pursued the RCPSC track for EM. 

Time always brings out more nuances. The same goes with a choice of speciality. 
 

Nearly a decade ago when I was entering the CaRMS match I was a mid 20s guy living in a bachelors condo. I was basically only responsible for myself. It was awesome being a resident and going golfing on a wed morning, having the links to yourself, when everyone else worked. A single 20 something year old, can’t really fully appreciate how life changes once you are married, have multiple kids and so on. So I did not fully factor in the shift work aspect on these things, I had no real way of knowing, despite thinking I knew back then  

 Now I’m married, have multiple kids, run businesses outside of emergency medicine. I’m anything but responsible only to myself. 
 

I still love the fact that I only spend 30-40% of my time in the hospital - still considered full time in EM. I like my time in the ED. I would like it less if the time was more than what I do. I generally feel well compensated for the time I spend doing EM. I have the means to comfortably do most things I want to do. I feel my work is rewarding. These are both huge factors that protect from burn out in my opinion. I know many other specialities would not as easily provide the time to pursue non-medical entrepreneurial ventures etc. I really enjoy these things, as much as medicine these days. So I’m really happy about this aspect of EM. 

But I certainly did not fully understand how shift work can influence family life. It is not without cost. Although I’m technically home about 60% of the time. About 50% of this time is not during family friendly hours . Don’t get me wrong, this is a great time to do non-family, non-medical things. But it isn’t time generally easily spent with kids or my partner. I did not really fully appreciate this fact back during CaRMS. 
 

For instance, every month I usually have a stretch of evening / night shifts that go about 4-5 days. I often imagine these stretches as similar to going away on a business trip, or maybe working in the airline industry. I sleep most of the day. And see little if anyone outside of the medicine world for these multiple days.

This said, being around during weird times also has it’s benefits come kids. Often I’m free for their school events, or random mornings and afternoons when the rest of the “normal” world is working their day job. Pretty much every month I have a week completely off without EM work. The shift work is a mixed blessing. 

I’m still in my early 30s. The physical aspect of shift work hasn’t really hit home for me. Older colleagues mention this. I know one day it will hit home for me too. Lots of studies demonstrate the physiological ramifications of shift work over the long term. It isn’t pretty. I think this is one of a multitude of good reasons to justify fair compensation for EM physicians. This probably does limit how long you can practice in a physically healthy manner. The timer on a strictly EM based career is likely shorter than is some other specialities. Again this was another factor I knew about come CaRMS, but probably minimized to a certain degree.

Would I have done things differently if I was to match again? Nope, no way. I still love EM. Probably more now than I did back during CaRMS. It’s a great career, with so much flexibility, and variability. 
 

It was mentioned that we are not the “experts” in anything. I think this is generally not true. We are the experts in identifying and managing immediately life threatening situations. Often the public may not see this stealthy expertise based on who discharges them after their life is saved. Sometimes other specialities may naively overlook this skill set because we consult them, often once the diagnosis is made, the patient is resuscitated or the differential narrowed to a handful of things... But the reality is that few physicians in the hospital have as much experience in resuscitation of multiple patients simultaneously, immediately emergent procedures, toxicology, environmental emergencies, mass causality management, crash airway management etc etc. This speaks to one of the most satisfying parts of the job. It is receiving a patient on the cusp of death with any various unknown problem every day. Identifying the issue, stabilizing them, then packaging them up for some other speciality has the chance to manage the temporized or mitigated acute issues with a “ribbon attached”. In this way I feel like EM docs are the “ninjas“, “marines” or “shock troops” of the healthcare system. ;) 


 

 


 

 

Edited by rogerroger

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1 hour ago, rogerroger said:

When I applied to CaRMS I knew I didn’t want any surgical speciality. Initially at the start of clerkship I was drawn to surgery but quickly learned the lifestyle and me didn’t mix. A big thing I learned during medical school about myself was that I enjoyed medicine, life long learning, the intellectual and social aspects of the field. But I could not be happy if medicine occupied the majority of my time. I simply had too many other interests that I enjoyed to give up more than 50% of my time to medicine. 

During my ward based rotations I also learned that these jobs would crush my soul. I just found the environment depressing, bureaucratic, and inefficient. To be frank, I just found it terribly boring. 

I still liked procedure based medicine, one of the things that drew me to surgery initially. For me, I also had zero interest in longitudinal care, but I really enjoyed the mystery solving aspect of medicine, and talking to various people, and getting undifferentiated cases on their way to being resolved. That was deeply rewarding, more so than the longitudinal care aspects of medicine. That’s how it was for me. 

Once I realized these things, I saw that there was few fields that were action oriented, quick paced, diagnostic in nature, involved direct patient care, had procedures, and avoided hospital wards. This pretty much only left emergency medicine. By the time CaRMS came around I couldn’t imagine doing anything else and enjoying a life in medicine as much as I could. The certainty on this realization was why I pursued the RCPSC track for EM. 

Time always brings out more nuances. The same goes with a choice of speciality. 
 

Nearly a decade ago when I was entering the CaRMS match I was a mid 20s guy living in a bachelors condo. I was basically only responsible for myself. It was awesome being a resident and going golfing on a wed morning, having the links to yourself, when everyone else worked. A single 20 something year old, can’t really fully appreciate how life changes once you are married, have multiple kids and so on. So I did not fully factor in the shift work aspect on these things, I had no real way of knowing, despite thinking I knew back then  

 Now I’m married, have multiple kids, run businesses outside of emergency medicine. I’m anything but responsible only to myself. 
 

I still love the fact that I only spend 30-40% of my time in the hospital - still considered full time in EM. I like my time in the ED. I would like it less if the time was more than what I do. I generally feel well compensated for the time I spend doing EM. I have the means to comfortably do most things I want to do. I feel my work is rewarding. These are both huge factors that protect from burn out in my opinion. I know many other specialities would not as easily provide the time to pursue non-medical entrepreneurial ventures etc. I really enjoy these things, as much as medicine these days. So I’m really happy about this aspect of EM. 

But I certainly did not fully understand how shift work can influence family life. It is not without cost. Although I’m technically home about 60% of the time. About 50% of this time is not during family friendly hours . Don’t get me wrong, this is a great time to do non-family, non-medical things. But it isn’t time generally easily spent with kids or my partner. I did not really fully appreciate this fact back during CaRMS. 
 

For instance, every month I usually have a stretch of evening / night shifts that go about 4-5 days. I often imagine these stretches as similar to going away on a business trip, or maybe working in the airline industry. I sleep most of the day. And see little if anyone outside of the medicine world for these multiple days.

This said, being around during weird times also has it’s benefits come kids. Often I’m free for their school events, or random mornings and afternoons when the rest of the “normal” world is working their day job. Pretty much every month I have a week completely off without EM work. The shift work is a mixed blessing. 

I’m still in my early 30s. The physical aspect of shift work hasn’t really hit home for me. Older colleagues mention this. I know one day it will hit home for me too. Lots of studies demonstrate the physiological ramifications of shift work over the long term. It isn’t pretty. I think this is one of a multitude of good reasons to justify fair compensation for EM physicians. This probably does limit how long you can practice in a physically healthy manner. The timer on a strictly EM based career is likely shorter than is some other specialities. Again this was another factor I knew about come CaRMS, but probably minimized to a certain degree.

Would I have done things differently if I was to match again? Nope, no way. I still love EM. Probably more now than I did back during CaRMS. It’s a great career, with so much flexibility, and variability. 
 

It was mentioned that we are not the “experts” in anything. I think this is generally not true. We are the experts in identifying and managing immediately life threatening situations. Often the public may not see this stealthy expertise based on who discharges them after their life is saved. Sometimes other specialities may naively overlook this skill set because we consult them, often once the diagnosis is made, the patient is resuscitated or the differential narrowed to a handful of things... But the reality is that few physicians in the hospital have as much experience in resuscitation of multiple patients simultaneously, immediately emergent procedures, toxicology, environmental emergencies, mass causality management, crash airway management etc etc. This speaks to one of the most satisfying parts of the job. It is receiving a patient on the cusp of death with any various unknown problem every day. Identifying the issue, stabilizing them, then packaging them up for some other speciality has the chance to manage the temporized or mitigated acute issues with a “ribbon attached”. In this way I feel like EM docs are the “ninjas“, “marines” or “shock troops” of the healthcare system. ;) 


 

 


 

 

How does the CCFP+1 training compare to what you experienced? I figure you most likely trained alongside them. 

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46 minutes ago, medigeek said:

How does the CCFP+1 training compare to what you experienced? I figure you most likely trained alongside them. 

This is by far one of the most common questions people who are interested in EM ask. Lots of good answers on here about it.  It’s also a reasonable question with perhaps an unsatisfying non-black and white answer. 
 

I did train along side CCFP-EM folks. Many of those attendings that trained me were also CCFP-EM. Some CCFP-EM that I trained along side, later were staff while I was still finishing my 5 year program. 
 

Can you learn everything you learn in 5 years in 1? No you cannot. At least not the regular average trainee in either program. Now that one year done by the CCFP folks is by far more clinically intensive then any year I had in the FRCPC stream. But it still can’t replace five years of time. This said, all this stuff you need to learn, you get exposure too in CCFP-EM. You totally come out of the program competent to practice. 
 

Now this all said, my impression is that a lot of fine tuning of practice for a CCFP-EM must still occur during the transition to staff. I reflect on my own training and most of my fifth year was basically geared towards optimizing department management skills - optimizing flow, time management, resources management etc. It took easily a year to develop this skill set to a way that I felt good about it. In hindsight I can say that because if this I felt ready to run an urban ED post exam. I think my transition to staff was as seamless as could be hoped for after finishing up. I imagine, this transition is a bigger jump for some CCFP-EM. Please, CCFP folks correct me if I’m wrong. 
 

At the end of the day, both streams teach you want you need to know. One is more of a fire hose in terms of delivery. The other is more of a steady stream of delivery with more theoretical pathophysiology tossed into the mix, and with a training wheels period.  
 

The other big difference between the two streams is that FRCPC has that one year to develop some sort of niche. So you need to account for that one year which is often outside of core EM, when comparing the two programs. 
 

There is good data that shows both programs get you to where you need to get to. 

Edited by rogerroger

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4 minutes ago, rogerroger said:

This is by far one of the most common questions people who are interested in EM ask. Lots of good answers on here about it.  It’s also a reasonable question with perhaps an unsatisfying non-black and white answer. 
 

I did train along side CCFP-EM folks. Many of those attendings that trained me were also CCFP-EM. Some CCFP-EM that I trained along side, later were staff while I was still finishing my 5 year program. 
 

Can you learn everything you learn in 5 years in 1? No you cannot. At least not the regular average trainee in either program. Now that one year done by the CCFP folks is by far more clinically intensive then any year I had in the FRCPC stream. But it still can’t replace five years of time. This said, all this stuff you need to learn, you get exposure too in CCFP-EM. You totally come out of the program competent to practice. 
 

Now this all said, my impression is that a lot of fine tuning of practice for a CCFP-EM must still occur during the transition to staff. I reflect on my own training and most of my fifth year was basically geared towards optimizing department management skills - optimizing flow, time management, resources management etc. It took easily a year to develop this skill set to a way that I felt good about it. In hindsight I can say that because if this I felt ready to run an urban ED post exam. I think my transition to staff was as seamless as could be hoped for after finishing up. I imagine, this transition is a bigger jump for some CCFP-EM. Please, CCFP folks correct me if I’m wrong. 
 

At the end of the day, both streams teach you want you need to know. One is more of a fire hose in terms of delivery. The other is more of a steady stream of delivery with more theoretical pathophysiology tossed into the mix, and with a training wheels period.  
 

The other big difference between the two streams is that FRCPC has that one year to develop some sort of niche. So you need to account for that one year which is often outside of core EM, when comparing the two programs. 
 

There is good data that shows both programs get you to where you need to get to. 

Good points! Thanks. How about regular CCFP. I've seen regular CCFPs sort of work through rural to medium sized community settings in the past 5-6 years. Did you see any of those during your training and how they transitioned?

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10 hours ago, rogerroger said:

 Now I’m married, have multiple kids, run businesses outside of emergency medicine. I’m anything but responsible only to myself. 

Given your current situation with family and such, do you think EM still provides a good lifestyle in terms of family time vs things like surgery, ICU, etc?

Also, if you don't mind me asking, how is community vs academic ED practice different?

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11 hours ago, rogerroger said:

When I applied to CaRMS I knew I didn’t want any surgical speciality. Initially at the start of clerkship I was drawn to surgery but quickly learned the lifestyle and me didn’t mix. A big thing I learned during medical school about myself was that I enjoyed medicine, life long learning, the intellectual and social aspects of the field. But I could not be happy if medicine occupied the majority of my time. I simply had too many other interests that I enjoyed to give up more than 50% of my time to medicine. 

During my ward based rotations I also learned that these jobs would crush my soul. I just found the environment depressing, bureaucratic, and inefficient. To be frank, I just found it terribly boring. 

I still liked procedure based medicine, one of the things that drew me to surgery initially. For me, I also had zero interest in longitudinal care, but I really enjoyed the mystery solving aspect of medicine, and talking to various people, and getting undifferentiated cases on their way to being resolved. That was deeply rewarding, more so than the longitudinal care aspects of medicine. That’s how it was for me. 

Once I realized these things, I saw that there was few fields that were action oriented, quick paced, diagnostic in nature, involved direct patient care, had procedures, and avoided hospital wards. This pretty much only left emergency medicine. By the time CaRMS came around I couldn’t imagine doing anything else and enjoying a life in medicine as much as I could. The certainty on this realization was why I pursued the RCPSC track for EM. 

Time always brings out more nuances. The same goes with a choice of speciality. 
 

Nearly a decade ago when I was entering the CaRMS match I was a mid 20s guy living in a bachelors condo. I was basically only responsible for myself. It was awesome being a resident and going golfing on a wed morning, having the links to yourself, when everyone else worked. A single 20 something year old, can’t really fully appreciate how life changes once you are married, have multiple kids and so on. So I did not fully factor in the shift work aspect on these things, I had no real way of knowing, despite thinking I knew back then  

 Now I’m married, have multiple kids, run businesses outside of emergency medicine. I’m anything but responsible only to myself. 
 

I still love the fact that I only spend 30-40% of my time in the hospital - still considered full time in EM. I like my time in the ED. I would like it less if the time was more than what I do. I generally feel well compensated for the time I spend doing EM. I have the means to comfortably do most things I want to do. I feel my work is rewarding. These are both huge factors that protect from burn out in my opinion. I know many other specialities would not as easily provide the time to pursue non-medical entrepreneurial ventures etc. I really enjoy these things, as much as medicine these days. So I’m really happy about this aspect of EM. 

But I certainly did not fully understand how shift work can influence family life. It is not without cost. Although I’m technically home about 60% of the time. About 50% of this time is not during family friendly hours . Don’t get me wrong, this is a great time to do non-family, non-medical things. But it isn’t time generally easily spent with kids or my partner. I did not really fully appreciate this fact back during CaRMS. 
 

For instance, every month I usually have a stretch of evening / night shifts that go about 4-5 days. I often imagine these stretches as similar to going away on a business trip, or maybe working in the airline industry. I sleep most of the day. And see little if anyone outside of the medicine world for these multiple days.

This said, being around during weird times also has it’s benefits come kids. Often I’m free for their school events, or random mornings and afternoons when the rest of the “normal” world is working their day job. Pretty much every month I have a week completely off without EM work. The shift work is a mixed blessing. 

I’m still in my early 30s. The physical aspect of shift work hasn’t really hit home for me. Older colleagues mention this. I know one day it will hit home for me too. Lots of studies demonstrate the physiological ramifications of shift work over the long term. It isn’t pretty. I think this is one of a multitude of good reasons to justify fair compensation for EM physicians. This probably does limit how long you can practice in a physically healthy manner. The timer on a strictly EM based career is likely shorter than is some other specialities. Again this was another factor I knew about come CaRMS, but probably minimized to a certain degree.

Would I have done things differently if I was to match again? Nope, no way. I still love EM. Probably more now than I did back during CaRMS. It’s a great career, with so much flexibility, and variability. 
 

It was mentioned that we are not the “experts” in anything. I think this is generally not true. We are the experts in identifying and managing immediately life threatening situations. Often the public may not see this stealthy expertise based on who discharges them after their life is saved. Sometimes other specialities may naively overlook this skill set because we consult them, often once the diagnosis is made, the patient is resuscitated or the differential narrowed to a handful of things... But the reality is that few physicians in the hospital have as much experience in resuscitation of multiple patients simultaneously, immediately emergent procedures, toxicology, environmental emergencies, mass causality management, crash airway management etc etc. This speaks to one of the most satisfying parts of the job. It is receiving a patient on the cusp of death with any various unknown problem every day. Identifying the issue, stabilizing them, then packaging them up for some other speciality has the chance to manage the temporized or mitigated acute issues with a “ribbon attached”. In this way I feel like EM docs are the “ninjas“, “marines” or “shock troops” of the healthcare system. ;) 


 

 


 

 

Thank you so much for your response @rogerroger. I've bookedmarked your post for future reference :)

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On 3/3/2020 at 5:07 AM, gangliocytoma said:

Given your current situation with family and such, do you think EM still provides a good lifestyle in terms of family time vs things like surgery, ICU, etc?

Also, if you don't mind me asking, how is community vs academic ED practice different?

Yes, very much so. I work on average 24hrs a week (you can do more if you felt inclined) as a full time physician. The only caveat is that you will spend about 30% of your off hours on a time zone opposite from your family. Which from your family’s perspective will feel like you are away more than 24hrs a week. But it’s still a very good lifestyle imo. 
 

My partner practices family medicine. I have a lot more free time. 

Edited by rogerroger

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On 2/27/2020 at 4:54 PM, PeterPatting said:

Thanks for doing this @magneto. How does the earning potential of EM compare with FM generally speaking? I know FMs can make quite a bit doing stuff like pain clinics for instance. While I'm asking, how does it compare to the earning potential as an FM-hospitalist? I know it's really hard to quote numbers, but even rough estimates would be really helpful :)

Thanks!!

Hard to compare the earning potential.

I believe FM-hospitalist and EM's will both earn roughly more or less in the same ballpark. I don't have any data to back that up other than some anectodal stories.

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