FM + 1 EM ... where to start

[ralk]

19 hours ago, LittleDaisy said:

You definitely can. I know a few preceptors who do emergency medicine full-time without the plus 1, in cities 1-2 hours within GTA area, and who subsequently challenge the EM qualification exam after 5 year of working experience. 

Recently CPSO wants the FM grads without +1 in EM who wish to do EM work, to be monitored for 3 months by a back-up EM physician, which could pose challenges to a few rural EM centers who could not afford to have 2 EM physicians at the same time, see recent policy: http://www.cpso.on.ca/CPSO/media/documents/Policies/Policy-Items/Expectations-Physicians-Emerg-Med-Rural-Practice.pdf

 

18 hours ago, A-Stark said:

Another fine example of the CPSO (and other colleges) coming up with policies that are either impractical, based on shoddy evidence/rationale, or both. 

Plenty of exceptions here, fortunately. Those who trained as residents in rural settings with a reasonable amount of ER experience, working in a similar setting with the same level of ER requirements, are exempted, for example. I think the idea is to prevent people training in urban centres with minimal ER training to simply jump into a rural ER for which they're really not qualified to work in. That makes sense to me and in many ways is already part of our guidelines (don't do things you're not qualified to do), this just removes the grey area for this specific circumstance.

[LittleDaisy]

2 hours ago, ralk said:

 

Plenty of exceptions here, fortunately. Those who trained as residents in rural settings with a reasonable amount of ER experience, working in a similar setting with the same level of ER requirements, are exempted, for example. I think the idea is to prevent people training in urban centres with minimal ER training to simply jump into a rural ER for which they're really not qualified to work in. That makes sense to me and in many ways is already part of our guidelines (don't do things you're not qualified to do), this just removes the grey area for this specific circumstance.

But CPSO still has to study your case, even if you do FM residency in rural area, and you do have to show proofs of your ER experience with ITERs. Then your file will be reviewed by registration committee, and the process itself takes a few weeks. A few of people that I know with a lot of ER experience end up asking for their ER chief to monitor them for 3 months; or act as back up and study their 10 files per month. 

The process itself takes awhile to set up; I just think that it disadvantages FM grads with no +1 in EM. If you aim for doing part-time EM after FM residency, obviously, people opt for ER electives+ anesthesia+ critical care during their residency. 

[medigeek]

On 4/25/2018 at 5:26 PM, Hanmari said:

I recently did an emerg rotation at UHN and I can confirm that there are many 2+1 ER docs there, although I am unsure how many are new hires.

Was there any difference in "quality" between the FRCP and +1s?

[ralk]

1 hour ago, LittleDaisy said:

But CPSO still has to study your case, even if you do FM residency in rural area, and you do have to show proofs of your ER experience with ITERs. Then your file will be reviewed by registration committee, and the process itself takes a few weeks. A few of people that I know with a lot of ER experience end up asking for their ER chief to monitor them for 3 months; or act as back up and study their 10 files per month. 

The process itself takes awhile to set up; I just think that it disadvantages FM grads with no +1 in EM. If you aim for doing part-time EM after FM residency, obviously, people opt for ER electives+ anesthesia+ critical care during their residency. 

Can't say I've heard of that requirement, do you have a source for that? The linked CPSO document clearly states that it does not apply to rural FM residents with significant ED training, and makes no mention of a file review for such residents.

[LittleDaisy]

3 minutes ago, ralk said:

Can't say I've heard of that requirement, do you have a source for that? The linked CPSO document clearly states that it does not apply to rural FM residents with significant ED training, and makes no mention of a file review for such residents.

I know a few people who do their residency in rural GTA, with significant amount of ER exposure, called CPSO as the policy recently came out, and has to submit further documentation pending review.  They still need to review your residency curriculum (rotations, ITERs) , making sure that you have significant ED exposure. And <<significant>> ED exposure is up to interpretation of CPSO file review committee, the people who contacted CPSO have been told that the process takes at least a few weeks. There are quite a few FM grads in the same boat, and some have to negotiate with their chief ED for 3 months of monitoring and back-up and 10 charts review monthly. 

The policy states: Family Medicine residents with substantial integrated rural and acute care training experience who want to practice in a similar rural environment when they complete their training. It also excludes recent graduates of rural family medicine residencies who had significant ED experience as part of their training

CPSO can't just take it for guaranteed as you do family medicine residency in rural area, that you have significant exposure to acute care+ ED, as curriculum varies so much between each faculty of medicine. 

 

[Hanmari]

10 hours ago, medigeek said:

Was there any difference in "quality" between the FRCP and +1s?

Not that I noticed! But I am neither in emerg nor very interested in the specialty so my opinion is worth next to nothing on the skills of ER physicians.

I did note that more FRCP docs were doing academic research, but even that is anecdotal.

[Edict]

On 4/25/2018 at 2:37 PM, plastics91 said:

 I have a question in regards to FM + 1 in EM as well. If we choose this route, is there no way for someone doing this to be able to work in a saturated place, for instance like in downtown Toronto? Assuming that the person does relevant research, works hard, etc.

Definitely not downtown Toronto, not anymore at least. But most places, like uptown Toronto probably are still hiring 2+1 EMs. A lot of this depends on where the 5 year EMs want to work, they are likely going to take precedence over a 2+1 EM in any location they want to work. There are a few 2+1+1 EMs with a yr in trauma who work in a lv 1 trauma center (non-Toronto) but i don't believe this would be easily doable anymore. With that being said, if you were really well liked, really good and you did an extra yr in trauma you probably could get a job in a trauma center. The further you leave medical school the less formal things become, so you can always find exceptions and you can usually make exceptions. 

[LittleDaisy]

On 4/27/2018 at 2:21 PM, Edict said:

Definitely not downtown Toronto, not anymore at least. But most places, like uptown Toronto probably are still hiring 2+1 EMs. A lot of this depends on where the 5 year EMs want to work, they are likely going to take precedence over a 2+1 EM in any location they want to work. There are a few 2+1+1 EMs with a yr in trauma who work in a lv 1 trauma center (non-Toronto) but i don't believe this would be easily doable anymore. With that being said, if you were really well liked, really good and you did an extra yr in trauma you probably could get a job in a trauma center. The further you leave medical school the less formal things become, so you can always find exceptions and you can usually make exceptions. 

I think that at Mount Sinai hospital- the majority of ER physicians are FM +1. However, I am unsure if for new staff, they prefer hiring FRCPC over FM+1 ( I would assume so)

In major trauma centre (Sunnybrook, St-Michael's hospital ) example, they only hire FRCPC. If you are willing to work in community hospitals in GTA or away from GTA, you shouldn't have trouble finding a job as FM +1. I do agree with edict, that they would prefer hiring FRCPC over FM +1 if they do have the luxury of choosing. 

[plastics91]

On 4/27/2018 at 2:21 PM, Edict said:

Definitely not downtown Toronto, not anymore at least. But most places, like uptown Toronto probably are still hiring 2+1 EMs. A lot of this depends on where the 5 year EMs want to work, they are likely going to take precedence over a 2+1 EM in any location they want to work. There are a few 2+1+1 EMs with a yr in trauma who work in a lv 1 trauma center (non-Toronto) but i don't believe this would be easily doable anymore. With that being said, if you were really well liked, really good and you did an extra yr in trauma you probably could get a job in a trauma center. The further you leave medical school the less formal things become, so you can always find exceptions and you can usually make exceptions. 

 

20 hours ago, LittleDaisy said:

I think that at Mount Sinai hospital- the majority of ER physicians are FM +1. However, I am unsure if for new staff, they prefer hiring FRCPC over FM+1 ( I would assume so)

In major trauma centre (Sunnybrook, St-Michael's hospital ) example, they only hire FRCPC. If you are willing to work in community hospitals in GTA or away from GTA, you shouldn't have trouble finding a job as FM +1. I do agree with edict, that they would prefer hiring FRCPC over FM +1 if they do have the luxury of choosing. 

Thanks guys for the reply and that makes sense! @Edict by year in trauma do you mean there is a possibility to train 1 more year specifically in trauma beyond FM+1EM? 

@Edict and @LittleDaisy, how much does someone's training or research come into play when it comes to hiring at major centres in Toronto? Is there a priority for either? Or is training most important then research is sort of icing on top? The reason I ask is because I am quite interested in research applicable to both FM & EM (a bit IM as well) which is why I'd like to do both in or near downtown Toronto where opportunities for research through collaboration is more bountiful

[LittleDaisy]

3 hours ago, plastics91 said:

 

Thanks guys for the reply and that makes sense! @Edict by year in trauma do you mean there is a possibility to train 1 more year specifically in trauma beyond FM+1EM? 

@Edict and @LittleDaisy, how much does someone's training or research come into play when it comes to hiring at major centres in Toronto? Is there a priority for either? Or is training most important then research is sort of icing on top? The reason I ask is because I am quite interested in research applicable to both FM & EM (a bit IM as well) which is why I'd like to do both in or near downtown Toronto where opportunities for research through collaboration is more bountiful

Both of us are not emergency medicine residents (FRCPC), I would rather an EM resident chimes in and answers your questions.

I think that the trauma fellowship is exclusively offered to general surgery and emergency medicine residents, at least to my understanding in Canada. However, nothing prevents you from doing a trauma elective during your 2 year of residency in FM. 

[Caliver]

In downtown Toronto, UHN and MSH have a large number of +1 ER docs. Not sure what the rationale is but politics probably plays a big role. In addition, at those centres, even though the patient population can be quite complicated, many specialty services are readily accessible. 

There is a noticeable difference between +1 and FRCSC docs when it comes to their comfort level for more complex issues (rather than just pattern recognition). I personally noticed this between St. Michael's vs. MSH/TGH/TWH in terms of the consult quality, although there are variabilities depends on the person. 

[Edict]

9 hours ago, plastics91 said:

 

Thanks guys for the reply and that makes sense! @Edict by year in trauma do you mean there is a possibility to train 1 more year specifically in trauma beyond FM+1EM? 

@Edict and @LittleDaisy, how much does someone's training or research come into play when it comes to hiring at major centres in Toronto? Is there a priority for either? Or is training most important then research is sort of icing on top? The reason I ask is because I am quite interested in research applicable to both FM & EM (a bit IM as well) which is why I'd like to do both in or near downtown Toronto where opportunities for research through collaboration is more bountiful

Yes, don't know the specifics but people have done a year in trauma after 2+1. Beyond that I really don't know sorry haha. 

[Arztin]

@OP, don't gun this early on for the 2+1. You will have time later for that. 

And regarding the hiring situation, I had the chance to talk to emerg staff working at Sunnybrooke and UHN. They usually prioritize FRCP over CCFP-EM in those large academic centers. Sometimes, when they need someone, and the only person available is a CCFP-EM, then they'll hire that person, which explains some of the recently hired CCFP-EM staff at Sunnybrooke.

Obviously, if at some point they need people, and there aren't enough FRCP graduates, for sure they will hire CCFP-EM, but if they have an oversupply of FRCP, they will go with the FRCP folks. At McGill, the RVH at some point was a FRCP only hospital. Since McGill doesn't produce enough FRCP, they had to start hiring CCFP-EM again.

However, the general tendency everywhere is that they prefer FRCP in academic centers. You can quickly look at CPSO - look at a hospital (UHN for example), look at all the emergency medicine specialists (i.e. FRCP), and then look at the family medicine - emergency medicine, and look at when they finished residency.

As people pointed out, it is very difficult to be good at EM and FM if you try to do both. I know a relatively fresh graduate at McGill who works as a full time emerg staff at the JGH - a very large tertiary non trauma center in Montreal, and works 8 days per period as a family doctor (4 of FM resident supervision, 4 of direct patient care) at the JGH affiliated family medicine unit. Basically, he's overworking right now. I highly doubt he'll keep working that much in a few years.

[medigeek]

22 hours ago, Arztin said:

@OP, don't gun this early on for the 2+1. You will have time later for that. 

And regarding the hiring situation, I had the chance to talk to emerg staff working at Sunnybrooke and UHN. They usually prioritize FRCP over CCFP-EM in those large academic centers. Sometimes, when they need someone, and the only person available is a CCFP-EM, then they'll hire that person, which explains some of the recently hired CCFP-EM staff at Sunnybrooke.

Obviously, if at some point they need people, and there aren't enough FRCP graduates, for sure they will hire CCFP-EM, but if they have an oversupply of FRCP, they will go with the FRCP folks. At McGill, the RVH at some point was a FRCP only hospital. Since McGill doesn't produce enough FRCP, they had to start hiring CCFP-EM again.

However, the general tendency everywhere is that they prefer FRCP in academic centers. You can quickly look at CPSO - look at a hospital (UHN for example), look at all the emergency medicine specialists (i.e. FRCP), and then look at the family medicine - emergency medicine, and look at when they finished residency.

As people pointed out, it is very difficult to be good at EM and FM if you try to do both. I know a relatively fresh graduate at McGill who works as a full time emerg staff at the JGH - a very large tertiary non trauma center in Montreal, and works 8 days per period as a family doctor (4 of FM resident supervision, 4 of direct patient care) at the JGH affiliated family medicine unit. Basically, he's overworking right now. I highly doubt he'll keep working that much in a few years.

Why would it necessarily be hard to be good at both? You can do 2 x 12 hour shifts a week for example and ~25 hours of clinic weekly too. I mean there are doctors who do that much clinic in an FHO setting then do something else (including ED) on the side. And if a place is reasonably busy, 24 hours a week of ED is enough to keep your skills up. 

 

Also is anyone surprised there's preference for FRCP? Seems pretty straight forward why...

[LittleDaisy]

1 hour ago, medigeek said:

Why would it necessarily be hard to be good at both? You can do 2 x 12 hour shifts a week for example and ~25 hours of clinic weekly too. I mean there are doctors who do that much clinic in an FHO setting then do something else (including ED) on the side. And if a place is reasonably busy, 24 hours a week of ED is enough to keep your skills up. 

 

Also is anyone surprised there's preference for FRCP? Seems pretty straight forward why...

To OP, if the hiring staff physician at downtown Toronto has two files in front of him & her, if he & she has to pick between a FRCPC and FM-EM, my gut is that people would go with FRCPC.

A lot of FRCPC EM residents that I talked to want to stay in academic centers, but the job of EM in academic downtown Toronto is not that easy to come by. If you want do EM through FM route, I would suggest that you become more flexible in terms of where you want to work  Especially with the new CPSO policy on enhanced supervision for FM grads without +1 in EM for 3 months, with 10 charts being audited every month, and having a more senior EM physician to be on back-up call. 

[plastics91]

Thanks a lot everyone for the contributions thus far, this is helping me a lot!

I had a question about a FM + 1EM physician who wants to do research in academic centres. It seems most conversations seem to suggest FM + EMs work in the community and do not take part in research, while FRCPC does more research.

Would it be possible for a FM+1EM to do research in an academic centre that impacts both fields, FM and EM? Assuming the person is flexible on picking up EM shifts in non-academic hospitals.

[Snowmen]

An FRCPC would indeed be in a better position to do research. If you were to do research as a +1 EM, it would most likely be EM research only as they typically do EM full-time and no FM.

[gangliocytoma]

On 5/8/2018 at 10:27 PM, plastics91 said:

Thanks a lot everyone for the contributions thus far, this is helping me a lot!

I had a question about a FM + 1EM physician who wants to do research in academic centres. It seems most conversations seem to suggest FM + EMs work in the community and do not take part in research, while FRCPC does more research.

Would it be possible for a FM+1EM to do research in an academic centre that impacts both fields, FM and EM? Assuming the person is flexible on picking up EM shifts in non-academic hospitals.

Unlikely. From what I understand EM departments in academic centres would be more likely to hire an FRCP over a +1EM. There are some older +1EM docs in my school that do conduct a fair bit of research (likely from the days before the FRCP program existed) but they're slowly being handed more admin related roles and having FRCPs (with fellowships) hop on to be the main research and clinical force.

[guy30]

On 5/8/2018 at 8:27 PM, plastics91 said:

Thanks a lot everyone for the contributions thus far, this is helping me a lot!

I had a question about a FM + 1EM physician who wants to do research in academic centres. It seems most conversations seem to suggest FM + EMs work in the community and do not take part in research, while FRCPC does more research.

Would it be possible for a FM+1EM to do research in an academic centre that impacts both fields, FM and EM? Assuming the person is flexible on picking up EM shifts in non-academic hospitals.

I've seen some +1 EM docs hold faculty positions and do EM research through the Department of Family Medicine at my school.  Not sure how common this is though.

[futureEP]

On 4/25/2018 at 6:43 PM, F508 said:

and you can re-apply to the +1 multiple times after you're in practice

Is this true? It seems like some programs only allow FM PGY-2 to apply while others consider currently practicing CCFPs as well. If this is true, couldn’t someone technically try to match into 2+1 forever and ever...

[Birdy]

18 hours ago, futureEP said:

Is this true? It seems like some programs only allow FM PGY-2 to apply while others consider currently practicing CCFPs as well. If this is true, couldn’t someone technically try to match into 2+1 forever and ever...

There is a re-entry process but it's really hard to get access to. 

[Mgmgrand]

50 minutes ago, Birdy said:

There is a re-entry process but it's really hard to get access to. 

Hey thanks for replying! Is the reentry process different from the plus one enhanced skills in emergency stream? Also how competitive is competitive? Based on Carms 2020 match statistics the plus one stream had a match rate of 66% and was relatively less competitive than FRCPC. 
 

To provide more context, I’m finishing third year with my core EM rotation and I love it! I can see myself doing this for the rest of my working life and really enjoying it. However, I don’t know if I’d be considered competitive for emerg as somebody who has an application geared towards psych so far. Any tips on how to proceed?  :/

 

[Mgmgrand]

1 hour ago, Birdy said:

There is a re-entry process but it's really hard to get access to. 

Hey thanks for replying! Is the reentry process separate from the plus one EM stream? Also how competitive is competitive? I’m looking at the Carms 2020 match statistics and it seems like the enhanced skills EM stream had a match rate of about 66% Which is relatively higher than FRCPC.

Also, to provide more context I am a third-year medical student finishing up core clinical rotations with emergency medicine. I absolutely love this last rotation. I am considering reshuffling my fourth your electives to cater my training more for an application in family medicine and possibly emergency medicine. Just wondering if this is a switch that should be entertained for someone that has an application predominantly geared towards psychiatry? Any help would be much appreciated! Thanks! 

[F508]

On 8/16/2020 at 4:15 AM, futureEP said:

Is this true? It seems like some programs only allow FM PGY-2 to apply while others consider currently practicing CCFPs as well. If this is true, couldn’t someone technically try to match into 2+1 forever and ever...

Some programs only allow finishing R2, others allow candidates already in practice. I think theoretically you could apply over and over again to Carms. However in reality, the further you are from training, the less competitive you will be. I presume much of the match decision is based on the candidate having done a rotation at the program. You need letters of recommendation as well. The further you're out in practice, the less you will be known to the program / the harder it will be to get a letter. 

Re-entry programs are separate from the Carms process. I don't know much about this.