emerg and anesthesia

[Elusive]

does anyone know of any doctors who are practicing both of these specialties (I have heard of it being done, but have never been given any names of the individual or where they're working now)? I would assume they did a 5 yr anesthesia residency, but how much extra training would be required to be eligable/desirable to be hired in an emerg department as well as work anesthesia??

 

Any names of individuals who have gone this route would be very appreciated!...

[ploughboy]

does anyone know of any doctors who are practicing both of these specialties (I have heard of it being done, but have never been given any names of the individual or where they're working now)? I would assume they did a 5 yr anesthesia residency, but how much extra training would be required to be eligable/desirable to be hired in an emerg department as well as work anesthesia??

 

Any names of individuals who have gone this route would be very appreciated!...

 

Hey,

 

I'm currently bouncing between the emergency and anaesthesia CaRMS tours and would be happy to flip some thoughts your way...just not until after the tour is over. Too much other stuff on my mind at the moment. I assume that you don't need this information acutely. PM me so that I don't forget to respond to you after CaRMS mayhem is over.

[Satsuma]

I have not come accross an anesthesiologist who works in the emerg.

However, I have come accross an emerg doc who did the same 1 year anesthesiology that family docs do and so does both. This doc does not plan on continuing with the anesthesiology bit though...just doesn`t find it interesting. It is not a common thing to do.

 

Another way you could do it would be to do family and then do a +1 emerg and +1 anest and work in a rural area.

[quickdraw_mcgraw]

James Menlove

 

STEGH

 

Chief of ER and anesthetist

[kosmo14]

Dr. Mike Murphey in halifax anesthesiologist and emergency

[ploughboy]

Dr. Rebecca Mallin, Hamilton/Brampton. RC emerg + GP anaesthesia

[UBCmed09]

One of my interviewers for gas at U of A was a resident who was previously a staff emerg doc in Hamilton I believe. Not sure if he was royal college or not though.

[ploughboy]

Ok, here's my thoughts on combining anaesthesia and emergency medicine training in Canada:

 

Probably the OP knows all of this stuff, but for anybody reading this thread in future let's start with some definitions before moving on to possible combinations:

 

There are three (four, really) ways to become an emergency doc in Canada:

 

1) FRCPC Emergency Medicine - five years of training in a dedicated emergency medicine residency program

2) CCFP-EM - two years of family medicine plus a formal PGY-3 year in emergency medicine

3) Challenge the CCFP-EM exam - two years of family medicine plus 1600 hours (400 hours x 4 years) of working in an ER with appropriate caseloads and supervision (for some arbitrary definition of "appropriate")

4) CCFP alone - forget challenging the exam. Just get your family medicine ticket and work in a peripheral emergency department without any extra training.

 

 

There are two ways to become an anaesthesiologist in Canada:

 

5) FRCPC Anaesthesioloogy - five years of training in a dedicated anaesthesiology residency.

6) GP Anaesthesia - usually done as a PGY-3 year after family medicine, but as indicated upthread it can be done as a PGY-6 year after FRCPC-EM.

 

 

Here are my own personal thoughts on each option:

 

1) FRCPC Emergency Medicine - At the end of this you can work anywhere in the country, and deal with anything that rolls in the door. RC docs tend to work in bigger centers (but not exclusively so) and be involved more in administration and research than CCFP-EM docs. But both paths produce great emerg docs.

 

The big advantage of going the Royal College route is that it opens up the opportunity to do fellowships (for example but not limited to: paeds ER, toxicology, sports med, critical care, transport med, forensics, medical education, trauma).

 

The potential downside, from my point of view, is that you're always going to be an emerg doc and you can't fall back into a 9-5 family practice the way a ccfp doc could if/when you ever get tired of shiftwork. That said, lots of emerg docs work in urgent care clinics and some programs (Manitoba?) qualify you for a GP licence along with your FRCPC ticket. I don't know a lot about that option, and I think the general licence might be province-specific. If you can see yourself doing only emergency medicine and don't mind shiftwork, that might not even be an issue for you.

 

 

2) CCFP-EM - Three years of training vs five for RC, but apparently after 5-10 years of practice the docs from the two training tracks are indistinguishable when it comes to clinical outcomes. My experience has been that the RC-EM guys have a great deal of respect for the FP-EM guys, and treat them as equals. Going this route lets you do full-service family medicine after you burn out from the ER.

 

Disadvantage - you'll potentially have less of a foot in the door when it comes to academic/administrative positions at large centres. On the other hand, a good emerg doc is a good emerg doc and there are well respected FP-EM guys at all the big centers.

 

 

3) Pretty much the same as option 2, except you save a year of residency. Downsides: finding a place that will let you work enough ER as a family doc (probably have to do this in the periphery somewhere) and personally I'd be worried that there would be things I wouldn't see during my four years working that I might get to see or study as part of a formal program. But that's just me.

 

 

4) Pretty much the same as option 3, except you're pretty much only ever going to work in smaller peripheral hospitals. Depending on your personal circumstances this may or may not be a big deal.

 

 

5) FRCPC Anaesthesia - Like option 1 above, it's a Royal College residency so at the end of it you can work anywhere, run any OR and you have fellowships available to you (ICU, pain, cardiac, obs, regional etc)

 

 

6) GP-A - Conventional wisdom has it that in 12 months you can teach *anybody* to give anaesthesia to a healthy patient. The reason the RC program is so long is that you spend the other four years learning what to do when the scheisse hits the fan. In contrast with emergency medicine, I've found (in my limited experience) that in anaesthesia there tends to be a little bit of a divide between the RC guys and the GP guys. Eg, there are lots of hospitals where there are only RC anaesthesiologists, but not very many hospitals where there are only RC emerg docs. Some of that is a supply/demand thing, but I think some of it is professional snobbery. As a GP-anaesthesiologist, you could well be limited to ASA-1 and ASA-2 cases in smaller hospitals.

 

 

Ok, so how about possible combinations of the two? There's a bunch of ways to tackle this:

 

 

A) CCFP + EM + GP Anaesthesia

 

This is a fairly common combination, especially in outlying areas where they'll really love you if you have all of these skills. You'll be the doc that everybody turns to when something major rolls into your hospital or when something bad happens in the middle of the night, and you can confidently deal with just about anything. But, you'd probably have to work in a peripheral center in order to be [movie announcer voice] The Family Doc Who Does Everything.

 

 

FRCPC Anaesthesia + CCFP EM

 

Two ways to approach this:

 

i) Do your CCFP-EM, start a GP-A and then transfer into an RC anaesthesia program. It's not uncommon for GP-A candidates to stick around the department for another 3-4 years and do a full RC residency. The only hiccough would be finding the $$ to pay for the extra years of residency. Where there's a will, there's a way I suppose.

 

ii) Or, I suppose you could do an RC anaesthesia residency and then do a family medicine residency. I don't know what (if any) credit the college would give for your previous training but I suspect you'd get 6-12 months credit. Worst case you'd be on the hook for 2-3 more years of residency, which is 2-3 years of *not* making money as an anaesthesiologist. That's a huge opportunity cost.

 

 

C) FRCPC EM + GP Anaesthesia

 

You could start with the RC residency and tack on a GP-A year (there's precedent for doing this, see upthread). Or you could start with CCFP-GPA, enter a CCFP-EM program and try to transfer into an RC EM residency that way. Makes my head hurt to think about it, but somebody somewhere has probably done it.

 

 

D) FRCPC Anaesthesia + FRCPC Emergency

 

Probably if you were sufficiently motivated and more than a little insane you could find somebody to pay for a second RC residency for you after your first one, and then be officially double-boarded in emergency medicine and anaesthesia.

 

The downside: 4-5 more years of residency

The upside: none at all that I can think of, other than bragging at parties. You'd have to be crazy to do this.

 

[Random aside: one of my EM preceptors did his residency with a guy who did FRCPC Internal Medicine, FRCPC Emergency Medicine and a Critical Care Fellowship. What did he wind up doing with all of those certifications? Personal physician to one of those obscenely rich Arab sheiks...]

 

 

I guess the take-home message I've discovered over the last little while is that there's a bunch of ways to approach this. Option A is common. Option D is dumb unless you want to work for the Sultan of Brunei. I'd think that options B and C are roughly equivalent, though as I mentioned above there seems to be more of a gap between RC and GP anaesthesia than there is between RC and GP EM, maybe making option B a little more attractive. Maybe that's just reflective of the places where I've worked, however.

 

 

The other question is *why* would you want to have a practice that combines anaesthesia and emergency? Only you can really answer that. The personalities of anaesthesiologists and emerg docs tend to be a little bit different, but there are certainly people who do both and are good at both. Personally I liked both rotations during clerkship and I think a lot of the skill-set overlaps, especially for the really sick patients (lines, tubes, fun drugs). The pace and structure of the day-to-day working environment is quite different for the two specialties, but when bad things happen in the hospital more often than not it's an emerg doc or an anaesthesiologist who shows up and stabilizes the situation.

 

I'd do option A in a heartbeat, except for the fact that on my ICU rotations I discovered that I like the sick patients so much that a critical care fellowship might be in my future. Of course I also would kinda like to have a general medical licence in my pocket, and the closest thing to that these days is a ccfp.

 

This has been one long stream-of-consciousness brain-dump. Hope it makes sense.

 

pb

[Ian Wong]

Wow! Great post! Critical care stuff is pretty cool as well, and can be a neat outlet (along with Pain) for anesthesiology-types who want more clinical/patient interaction stuff than what a traditional OR setting can provide.

 

Ian

[Halcyon]

But, you'd probably have to work in a peripheral center in order to be [movie announcer voice] The Family Doc Who Does Everything.

 

Really enjoyed the post, ploughboy. Love the "FM doc who does everything" line, especially said in a movie announcer voice!

[Elusive]

Thanks for all the great info guys..

To Ploughboy...I'll PM you after the Carms interview period is over.