Jump to content
Premed 101 Forums

FRCPC or CCFP-EM - the eternal EM discussion


Recommended Posts

On 6/2/2018 at 4:37 PM, The Bunny said:

I am a CCFP-EM working in a tertiary care hospital in BC doing full time emergency medicine. We teach medical students and residents including the occasional 5 year elective resident. I do not do any research but my center is looking to grow in that area and I totally could if I wanted. 

As for who is hiring, I finished my EM year 2 years ago. 2 of my cohort are working in large academic centers not in BC. As far as I know, the only places in Canada that restricts to hiring 5 year EM residents are VGH and maybe st. Mike’s in Toronto. Everywhere else, I have heard of CCFP-EMs being hired in the last few years. It’s all about talking to the right person at the right time. 

Thanks for your input, The Bunny! It’s very helpful to hear from a real CCFP-EM doc :)

Link to comment
Share on other sites

  • 3 years later...
On 6/2/2018 at 1:37 PM, The Bunny said:

I am a CCFP-EM working in a tertiary care hospital in BC doing full time emergency medicine. We teach medical students and residents including the occasional 5 year elective resident. I do not do any research but my center is looking to grow in that area and I totally could if I wanted. 

As for who is hiring, I finished my EM year 2 years ago. 2 of my cohort are working in large academic centers not in BC. As far as I know, the only places in Canada that restricts to hiring 5 year EM residents are VGH and maybe st. Mike’s in Toronto. Everywhere else, I have heard of CCFP-EMs being hired in the last few years. It’s all about talking to the right person at the right time. 

Sorry to bump an old post, but do you see large community hospitals in BC (eg. Royal Jubilee, Victoria General) bringing on CCFP-EMs who’ve done the “practice eligible” route through accumulating the 400 hours/year? Or are “practice eligible” CCFP-EMs seen as inferior to people who’ve done the pgy3 

Link to comment
Share on other sites

1 hour ago, The Bunny said:

They hire practice eligible EMs who have passed. Most of the other docs don’t know how you obtained it. It’s not important. 

Anecdotally, my colleagues who do full-time EM, can definitely tell the difference between +1 vs practice eligible routes, when practicing in bigger centres than rural posts. The volume and type of care provision is simply just different through the pathways, and the types of hospitals you can work without CCFP EM to collect those 2000+hours. Though it probably evens out after a while, much like people say it evens out for 5yr vs +1.   

Having a focused year of full-time EM experience as a +1 trainee makes a big difference, just like having an extra 2-3 years of focused full time experience as a 5 year makes a difference.

From a hiring perspective, they will still hire you if they need you of course, and if they like you.  "don't know how you obtained it" may not be accurate, as anyone who sees your CV will see that you didn't do the +1. 

Link to comment
Share on other sites

  • 1 year later...

Hey question about $ : I got the understanding that CCFP-EM use the same codes than FRCPCs so they have exactly the same pay for same amount of work. 

But I heard recently that it wasn't the case for FPs (who don't have the +1) because they are not using the same codes. 

Is this true? 

What about FPs who got their EM certificate after years of experience? 

Link to comment
Share on other sites

4 hours ago, no-name said:

Hey question about $ : I got the understanding that CCFP-EM use the same codes than FRCPCs so they have exactly the same pay for same amount of work. 

But I heard recently that it wasn't the case for FPs (who don't have the +1) because they are not using the same codes. 

Is this true? 

What about FPs who got their EM certificate after years of experience? 

I don’t see why it would matter whether you are FM with or without an EM year or having passed the exam with respect to billing codes (at least in Ontario where I am training). Take a look for yourself at ohipcodes.com 

The only instance that I know of where an FR trained emerg doc will make more is in a “consult” (see H055 vs H065 billing codes from OHIP). The FR doc gets $106.80 per consult vs $81.25 for CCFP (with or without EM probably). Now, I am FM PGY2 starting PGY3 EM in July, but my understanding is these consults tend to only get billed when a family doc sends their patient to the ED with a consult letter in hand and/or faxed over (that’s how they do it in the rural community I’m training in anyway). I doubt this code is enough to make a significant difference in the long run though

Link to comment
Share on other sites

On 5/28/2023 at 6:16 PM, no-name said:

Hey question about $ : I got the understanding that CCFP-EM use the same codes than FRCPCs so they have exactly the same pay for same amount of work. 

But I heard recently that it wasn't the case for FPs (who don't have the +1) because they are not using the same codes. 

Is this true? 

What about FPs who got their EM certificate after years of experience? 

In Quebec, FRCP have a completely different set of billing codes. CCFP-EM or CCFP bill another set of codes. FRCPs bill (anecdotally) about 30% more.

From what I understand, there is no difference for other provinces, at least, in BC and ON. (other than the consult fees mentionned above for Ontario) 

Link to comment
Share on other sites

  • 8 months later...

The FR Doctors will definitely make more because we have better training, and we can make decisions, faster, and we can see more patients on average. 
 

however, this point doesn’t really matter. If you really want to do emergency medicine, do the FR program if you can get in. If you aren’t sure do family medicine first. 

If you aren’t lucky enough to get into the FR program, then do family medicine and try the plus 1. 
 

There is no doubt in my mind that they are not equivalent programs. The FR is absolutely superior, but it’s not necessary to be a good emergency medicine doctor. 

 

 

Link to comment
Share on other sites

On 2/15/2024 at 9:52 PM, MountainAmoeba said:

The FR Doctors will definitely make more because we have better training, and we can make decisions, faster, and we can see more patients on average. 
 

however, this point doesn’t really matter. If you really want to do emergency medicine, do the FR program if you can get in. If you aren’t sure do family medicine first. 

If you aren’t lucky enough to get into the FR program, then do family medicine and try the plus 1. 
 

There is no doubt in my mind that they are not equivalent programs. The FR is absolutely superior, but it’s not necessary to be a good emergency medicine doctor. 

 

 

By the time an FR is in practice, an EM that start at the same time has been working as staff for 2 years. In my experience working in centres with a frequent mix of both, it’s pretty hard to tell the difference between the two after a couple years in practice. Billings are also indistinguishable.
 

I actually think a bigger factor in decision making is what you want to do after. E.g., An EM can’t apply for some fellowships like critical care, and it’s harder to get into some areas like transport, etc. 

Link to comment
Share on other sites

On 2/15/2024 at 11:52 PM, MountainAmoeba said:

The FR Doctors will definitely make more because we have better training, and we can make decisions, faster, and we can see more patients on average. 
 

however, this point doesn’t really matter. If you really want to do emergency medicine, do the FR program if you can get in. If you aren’t sure do family medicine first. 

If you aren’t lucky enough to get into the FR program, then do family medicine and try the plus 1. 
 

There is no doubt in my mind that they are not equivalent programs. The FR is absolutely superior, but it’s not necessary to be a good emergency medicine doctor. 

 

 

Respectfully, I feel you are wrong on a lot of points. I am not sure if you are a resident or staff... but the superiority complex is quite evident in your statement 

"we can make decisions faster, and see more patients on average" - based on my experience in several provinces, the efficiency is based of your experience and the type of physician you are. I have seen many FR physicians be "slower" but they incorporate a lot of empathy and patient-centered decision making in their practice. 

It is not absolutely superior - working in the emergency room after a few years, both types of physicians provide amazing care and you truly cannot tell the difference between most physicians. 

The great benefit of the EM, for me specifically of why I chose it, is that I am able to do a dual practice - which for me is important not to burnout. 

There are some fellowships you can do after EM, but there are definitely more opportunities for that with the FR.

To avoid a toxic work culture, we cannot view one program as being superior compared to another. They each have their pros and cons, and you are right that either program will make you an amazing emergency doctor at any center. 

Link to comment
Share on other sites

  • 2 weeks later...
On 2/15/2024 at 11:52 PM, MountainAmoeba said:

The FR Doctors will definitely make more because we have better training, and we can make decisions, faster, and we can see more patients on average. 
 

however, this point doesn’t really matter. If you really want to do emergency medicine, do the FR program if you can get in. If you aren’t sure do family medicine first. 

If you aren’t lucky enough to get into the FR program, then do family medicine and try the plus 1. 
 

There is no doubt in my mind that they are not equivalent programs. The FR is absolutely superior, but it’s not necessary to be a good emergency medicine doctor. 

 

 

Hi there. 4th year attending here. Plain CCFP in my case, working in a large urban hospital where everyone else is FR or EM. You must really be laughing at me now.

From my experience, residents, nurses, consultants all can't tell unless they ask.

I've seen a lot of new docs at this point. FRCPs take about 3-6 months to become "ripe". CCFP-EM grads take about a year, and typically during their first year will ask more questions. After 2-3 years, they become "comfortable junior" attendings.

I once saw a FRCP EM PGY-5 who already wrote and passed the RC exam who assessed a patient dying of a cardiac issue and rightfully put the patient in palliative care. Patient was already unconscious. However, they put the orders of : give O2 to keep O2 sat above 92 percent. I've never seen any other person in anyother pathway of training do that, esp at the PGY5 level. Lack of common sense? or lack of training in that area? Who knows.

During training, I've worked with a super good FRCP not knowing what to do for a T2 diabetes patient with suboptimal control with only metformin, not in DKA nor HHS. Pt doesn't have a FM anymore, and endo consult would take months. You can argue that the patient doesn't have an emergency and hence is not an EM problem. Being FM trained, I knew what to do.

I've worked with FRCP docs (with an S), who, even when they suspect a cancer in a patient, won't scan because they consider the patient to not have an acute emergency. 

Point being, If you use anecdotes like these, you can support any kind of narrative (toxic and damaging in your case) you want. 

That being said, either pathway has its pros and cons. At the end of the day, with the right attitude, with hard work, both produce great EM docs. 

Real life EM isn't what you see in the Ivory towers.

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
×
×
  • Create New...