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White-Tiger

CCFP(EM) in the US?

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To practice in the united states doing emergency medicine requires two things.

 

1. state license. you can only obtain this by passing all steps of the usmle and applying for a medical license in the state of your choice.

 

2. Board certification or Board eligibility in one of the following specialties, Internal Medicine, Family Medicine, Emergency medicine.

 

How does that apply to Canadians:

 

ok, gets a little complicated. first of all Emergency medicine in a larger city or an academic centre universally requires Board Certification by the ABEM(American Board of Emergency Medicine). In other words the letters DABEM have to be behind your name to get a job in a reasonable size city or academic centre. A canadian with ccfp em cannot obtain the letters DABEM after his/her name. The reason is that the ABEM does not recognize CCFP EM as an acceptable training pathway to challenge the ABEM exam. They do however recognize the FRCP pathway as equivalent residency training and open the exam to those candidates having completed this residency pathway.

 

The situation in smaller places, say 200,000 or less is even more confusing. As it stands currently (largely because of manpower issues), Smaller Emergency departments in the US will allow physicians with board certification in Internal medicine, family medicine and of course ER to work in the department. Some will even allow those that are Board eligible (not board certified, the difference being that a board eligible candidate fulfills the requirements for TRAINING to challenge the certification exam for their specialty, but has not actually written or passed the exam) to work in the ER.

 

Again how does this translate to canadians. Family medicine training in the US is three years, however here it is 2 years. For a Canadian CCFP graduate to be board eligible to write the family medicine exam for the American Board of Family Practice (ABFP) requires another year of training, the Canadian R3 EM year is acceptable to the board to fulfill that.

 

So someone who is CCFP EM is board eligible to write the American certification exam for Family medicine. However they are not board eligible to write the ABEM exam. Because they are Board eligible for Family Medicine, some ER's will hire them based on this qualification. Certain ER's that are familiar with Canadians do consider (for hiring purposes) CCFP EM to be board equivalent to ABEM but that is a regional thing and at the level of board cerification CCFP EM is practically an unkown entity to the ABEM.

 

Cold hearted

CCFP EM resident.

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Thank you for that very informative reply cold.

 

So from your post, I can see a huge advantage to getting your (EM) certification via the extra year route because it will allow you to become certified in Family Practice in the US. I assume this would not be the case for doctors who acquired the (EM) through the practice route, right?

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American Board of Family Medicine:

 

"The Board prefers all three years of training to be in the same ACGME-accredited family medicine program; however, other training may be considered as equivalent. Programs seeking to admit a resident into training with credit toward certification for other types of previous accredited training, including training in another ACGME-accredited family medicine program, are no longer required to obtain prior approval for transfer/advanced placement of 12 months or less for residents transferring from:

• ACGME-accredited family medicine programs

• Other ACGME-accredited specialties

• American Osteopathic Association (AOA) approved programs

• Canadian programs approved by the College of Family Physicians of Canada

....

The American Board of Family Medicine has developed reciprocity agreements with the College of Family Physicians of Canada

....

 

Canadian applicants may qualify for examination via either of the following routes:

 

1. Physicians who have satisfactorily completed two years of training in a family medicine residency program accredited by the College of Family Physicians of Canada may apply for certification by the ABFM upon the successful completion of a third year of accredited family medicine residency. The third year of training must be satisfactorily completed in an ACGME-accredited family medicine program or, if taken in Canada, must be approved by the College of Family Physicians of Canada. The third year must have prior approval of the American Board of Family Medicine and bring the

total residency experience into compliance with the ACGME Program Requirements for Residency Education in Family Medicine. The request must be accompanied by documentation of satisfactory performance of the first two years of training (including a description of the curriculum) signed by the Program Director.

 

2. Physicians who have passed the College of Family Physicians of Canada (CFPC) Certification Examination in Family Medicine may apply to sit for the American Board of Family Medicine Certification Examination if they:

a) are certified by exam and a member in good standing of the College of Family Physicians of Canada at the time of application

B) have completed postgraduate residency training in family medicine accredited by the College of Family Physicians of Canada

c) have been a resident of the United States for at least six (6) months

d) hold a valid and unrestricted license to practice medicine in the United States

e) are actively involved in family medicine in the United States

Physicians approved to take the examination must maintain their good standing in the CFPC through the date of the examination."

 

you do NOT need a third year.

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There is now an alternative route for those physicians who are either unable or unwilling to take the ABEM, AOBEM, or RCPSC exams, which is the Board of Certification in Emergency Medicine. The BCEM is the newest certifying body in emergency medicine, and since 1988 the only organization in the United States that will grant "board certification" in emergency medicine to a physician who has not completed an emergency medicine residency. It is under the authority of the American Board of Physician Specialists/American Association of Physician Specialists.

 

Look here for eligibility...

http://www.abpsus.org/emergency-medicine-eligibility

 

the main point is this one:

Be qualified under one (8a, 8b, or 8c) of the following:

 

8a Completed an ACGME or AOA-accredited residency in Emergency Medicine. (Meeting this requirement also satisfies the residency requirement specified in item 7.)

8b The applicant must have practiced Emergency Medicine on a full-time basis for five (5) years AND accumulated a minimum of 7,000 hours in the practice of Emergency Medicine AND satisfy either I or II:

I. Completed an ACGME or AOA-accredited Primary Care residency (Meeting this requirement also satisfies the residency requirement specified in item 7.)

 

OR

II. Be certified in a Primary Care specialty by an ABPS, ABMS, or AOA-recognized board of certification (Meeting this requirement does not satisfy the residency requirement specified in item 7.)

8c. Graduate Training Program: Completed either a 12 or 24-month Emergency Medicine graduate training program approved by the BCEM. Physicians completing a 12-month graduate training program must have practiced Emergency Medicine on a full-time basis for an additional 12 months, before or subsequent to completing the graduate training program. (This Graduate Training Program does not constitute a residency program, and does not fulfill the residency requirement specified in item 7.)

 

Currently, the BCEM has approved the following graduate training programs:

* Emergency Medicine Fellowship/affiliated with the University of Tennessee at Memphis(http://www.emfellowship.com)

* University of Tennessee at Jackson(http://www.uthsc.edu/UTFamJac/erfellowship.php)

* University of Tennessee at Knoxville(http://gsm.utmck.edu/family_medicine/emergencymed.cfm)

NOTE: For the purpose of defining "full-time" practice, the BCEM requires verification of a minimum of 1,400 hours per 12-month period. Verification of less than 1,400 hours in a 12-month period will not be accepted.

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so, if I understand well, for a FM resident in Canada be certified by BCEM (not ABFM) he/she has to do, in consequence:

 

1) complete 2 yrs CFPC residency

2) do a R3 in a +1 program, could be anything - dosen't have to be CFPC-EM

3) now he/she accumulated 3 yrs in primary care, so he/she can apply for BCFM

4) once certified ABFM, the candidate now has "an ACGME-certified Primary Care residency" - apparently ACGME don't certify fresh 2-yr CFPC for primary residency

5) accumulate 7000 hrs in ER, with 1400+ hr/yr

6) now eligible to write the BCEM exam

 

my question:

can we skip step 3) ?

I mean if CFPC 2+1 is certified by American authorities as primary care residency (it is 3 yrs too), then we won't need to get ABFM before BCEM.

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I believe the answer is generally yes, you need to have all 3 steps of the USMLE done in order to have a license to practice medicine in the US.  

 

 

In addition, each state puts requirements on the minimum amount of post-graduate residency training an individual must have obtained in order to obtain licensure. I think it needs to be ACGME accredited training but they don't always explicitly say that.  I'm also pretty sure all Canadian residency is considered equivalent to ACGME so both the FRCP and CCFP(EM) training should count this should count.  

 

The minimum number of years for residency required may differ between US grads and IMG's with IMG's often requiring more.  I would think CMG would be considered in the US grad category here but they only state that for one state (Maine).  Generally the US grad requirement is at least 1-2 years and IMG requirement is about 3 years.  Again, both FRCP and CCFP(EM) fit the bill here.

 

This table outlines it pretty nicely:

https://www.fsmb.org/licensure/usmle-step-3/state_specific 

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Now I haven't looked at this in great detail, however from talking to people, my understanding is that there are some states in which you do not need to have written the USMLE in order to obtain a license to practice. Certain states will consider your LMCC as an equivalent. 

 

Also, I don't think you can practice as an ER physician in the states with CCFP-EM. It is not portable like FRCP.

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Now I haven't looked at this in great detail, however from talking to people, my understanding is that there are some states in which you do not need to have written the USMLE in order to obtain a license to practice. Certain states will consider your LMCC as an equivalent. 

 

Also, I don't think you can practice as an ER physician in the states with CCFP-EM. It is not portable like FRCP.

 

Yeah I've heard of the LMCC being considered equivalent in some states too but I couldn't find anything specific to back that up in my quick search so maybe someone else has more info on that?

 

In terms of doing ER in the US, I think it's important to differentiate between being able to do it and actually getting hired to do it. As a CCFP(EM), you'd be able to become board certified in family medicine which has a scope that allows you to practice emergency medicine. However, to be hired in any major center (and to have insurance companies be willing to pay you) it will be difficult and just like in Canada as a family doc, you'd be more likely to be hired in a peripheral community or rural center.

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I had posted this in another forum but some help would be awesome.

 

"Hi,

 

I am a Canadian who is currently a first year student in the US. I want to apply for family residency in Canada and I was also interested in doing the +1 in EM. Based off conversations with my Canadian friends who are currently in/graduated medical school as well as this forum, it seem that acquiring the +1 is difficult. I was wondering anyone had information as to if US programs also offer a plus 1 similar to that in Canada and if it would be recognized in Canada?"

 

p.s: I now know that University of Tennessee at Memphis and Knoxville offer the graduate training program in EM for 1 year I believe. Now if you completed your practice in Canada (2 yr FM program) does that pose a problem for example at U of Tennessee because in their website they stated that one requirement was "Completion of an ACGME or AOA approved Family Medicine Residency Program, with a letter from the Program Director documenting training??". Other schools seem to state that was well

 

http://www.uthsc.edu/UTFamJac/erfellowship.php

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Hi,

 

CCFP (EM) would be able to practice family medicine in the states as it is mentioned earlier in this forum (and makes sense and also mentioned on ABFM website in a way or another).

My Q: Does it matter if the EM part was obtained through residency (+1) or through practice?

As you guys may know there are two pathways to obtain eligibility to sit for EM exam for CCFP holders - either plus a year of residency or after practicing certain hours in emergency medicine over a certain period of time. Both pathways will make you eligible to sit for the exam that leads to CCFP (EM).

 

Cheers,

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