Jump to content
Premed 101 Forums

Ask questions about emergency medicine here


Recommended Posts

On 5/23/2020 at 5:27 AM, rmorelan said:

first thought - passing an exam without the support and guidance of a full program? That sounds horrible (doing the same with full support and resources for my exam was literally the most academically stressful thing I have ever done ). The exam history you get at the school it extremely valuable. 

I’m totally bias here being trained in the 5 year stream. But I just can’t fathom one being able to accumulate the equivalent knowledge, confidence, and department management skills needed without dedicated support provided by a training program. 
 

Becoming an expert in emergency medicine takes more than some CME, some hours logged and an exam. 

Edited by rogerroger
Link to post
Share on other sites
  • Replies 121
  • Created
  • Last Reply

Top Posters In This Topic

Top Posters In This Topic

Popular Posts

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

Here you go:   Just joking here with the picture above. I don't have a definition. However, there are some medical students who just don't give a good vibe to others. Examples

In a way it would make more sense for it to be the exact opposite (not that I'm advocating for that). To come to a provisional diagnosis and manage a patient without having CT available is probably a

Posted Images

On 5/29/2020 at 12:11 PM, rogerroger said:


I went into my emergency medicine residency considering critical care. It was one of a handful of potential options I was considering for the “extra specialization year” built into the 5 year training. 
 

In my first three years of residency I spent just shy of 1/2 year in the ICU, and didn’t like it that much. In the ED sick patients often get better, get worse, die, or stay the same and get admitted over the course of a shift. The ICU with all it’s hours of rounding and the gradual changes in patients status didn’t really fit what I was looking for from a work satisfaction standpoint. Don’t get me wrong. There is also some fascinating medicine going on there. When it was interesting, it was really interesting. But it just didn’t have the turn around of the ED which I really enjoy. 

My impression is that critical care docs work really hard when they are on. There are different models out there, but many cover the ICU for a couple days. Those few days seem to be fairly focused on the ICU with call etc. During the off times most of these folks go back to their regular programming, such as being an emerg doc, anesthesiologist, respirologist, surgeon, etc.. I imagine what sort of overall lifestyle this job presents is probably highly dependent on what else you are doing when not covering the ICU.

As an aside, the ICU rotations during emergency medicine training are some of the highest yield over the five years. Many residents come out of the ICU and return to the ED with a much improved repertoire of knowledge and skills. So even if critical care isn’t your cup of tea, it’s hugely translatable towards determining the type of emerg doc you will be.

 

thank you!

Link to post
Share on other sites
  • 1 month later...
On 5/23/2020 at 7:18 AM, medigeek said:

How come you say it's a lot of work and dedication? You're working and making physician income, while accumulating hours. The remaining part is passing the exam, which is the same exam PGY3 people write.  

It is a lot of work because you need to work in emergency department and sometimes it may not be easy if you live in a large city and cannot move. In addition, you need to keep up with the reading and procedural skills outside of practice because often you are working in emergency departments with no back up. It takes a while to accumulate the hours and some people may just lose interest over time.

Link to post
Share on other sites
On 5/23/2020 at 12:18 AM, medigeek said:

How come you say it's a lot of work and dedication? You're working and making physician income, while accumulating hours. The remaining part is passing the exam, which is the same exam PGY3 people write.  

Also, as of this year requirements for practicing physicians have changed. The most significant change is that the site the physician is working at must have advanced imaging such as CT. This means that docs working in smaller rural centers with no CT cannot use those hours to qualify to write the exam. A lot of people who have been working towards practice eligibility are now excluded and quite upset. 
https://www.cfpc.ca/en/education-professional-development/examinations-and-certification/examination-of-added-competence-in-emergency-medic/eligibility-and-application

Link to post
Share on other sites
41 minutes ago, The Bunny said:

Also, as of this year requirements for practicing physicians have changed. The most significant change is that the site the physician is working at must have advanced imaging such as CT. This means that docs working in smaller rural centers with no CT cannot use those hours to qualify to write the exam. A lot of people who have been working towards practice eligibility are now excluded and quite upset. 
https://www.cfpc.ca/en/education-professional-development/examinations-and-certification/examination-of-added-competence-in-emergency-medic/eligibility-and-application

 

I believe they have discussed this and are looking at a way to not exclude rural docs in this context. This includes possibly revising the new criteria soon.

"Rural" is also a bit of a vague term. There are places that see a fair bit of acuity and range of pathology but doing a CT involves sending a patient out 25 minutes. you generally need far stronger clinical skills in those settings. And lets be serious here - how many central lines or airways are actual academic staff even doing? They "supervise" them. The small community (aka most of which is "rural") guys are doing the procedures all alone without any help in house. 

Link to post
Share on other sites
  • 4 months later...

1. For the FRCPC program, how many allow moonlighting? Is it common? How much  do residents make generally doing it in a yr? (and how many hours do they work, given other duties)

2. Where is it possible to practice full time emergency medicine without the +1 in em? (in Ontario for example). Wondering about non-rural locations e.g. small cities / suburbs? Do you see this changing?

3. If an emerg doc gets burned out, what are possible avenues to a 9-5?

Link to post
Share on other sites
  • 4 weeks later...
On 12/5/2020 at 9:44 PM, medstudent123456 said:

1. For the FRCPC program, how many allow moonlighting? Is it common? How much  do residents make generally doing it in a yr? (and how many hours do they work, given other duties)

2. Where is it possible to practice full time emergency medicine without the +1 in em? (in Ontario for example). Wondering about non-rural locations e.g. small cities / suburbs? Do you see this changing?

3. If an emerg doc gets burned out, what are possible avenues to a 9-5?

Can answer #2: places like Kitchener /Waterloo/Cambridge/Stratford/Alliston/ tilsonburg/uxbridge/Orangeville/Georgetown/Niagara area off the top of my head are places where I’ve seen colleague ccfps without EM being hired in last 3 years. U of T also has 3 mth SEME program to help develop EM skills for FM grads. 

would also add that once you have the EM certification via the 4 year practice route, it may not be easy to return to gta. Chiefs may still prefer to hire FRs and Ccfp-ems out of residency.

 

Link to post
Share on other sites
1 hour ago, Lock123 said:

Can answer #2: places like Kitchener /Waterloo/Cambridge/Stratford/Alliston/ tilsonburg/uxbridge/Orangeville/Georgetown/Niagara area off the top of my head are places where I’ve seen colleague ccfps without EM being hired in last 3 years. U of T also has 3 mth SEME program to help develop EM skills for FM grads. 

would also add that once you have the EM certification via the 4 year practice route, it may not be easy to return to gta. Chiefs may still prefer to hire FRs and Ccfp-ems out of residency.

 

I'm not from ON but just did a quick google search. Georgetown, ON (part of the GTA) is only a 40 min drive from downtown Toronto. So doesn't this mean you could live in downtown Toronto and work as an ER doctor in Georgetown after just 2 years of FM residency? This seems too good to be true lol. There are some cities in Canada where plenty of people's commute to work is longer than that and they live/work in the same city..

Are these ER jobs in these mostly commutable locations from downtown Toronto really coveted by FM grads/doctors (ie are they hard to get)??

Link to post
Share on other sites
1 hour ago, Lock123 said:

Can answer #2: places like Kitchener /Waterloo/Cambridge/Stratford/Alliston/ tilsonburg/uxbridge/Orangeville/Georgetown/Niagara area off the top of my head are places where I’ve seen colleague ccfps without EM being hired in last 3 years. U of T also has 3 mth SEME program to help develop EM skills for FM grads. 

would also add that once you have the EM certification via the 4 year practice route, it may not be easy to return to gta. Chiefs may still prefer to hire FRs and Ccfp-ems out of residency.

 

Do you know if they're offering mentoring to those new hires as well? 

And the 4 year practice route makes you more eligible for large community hospitals jobs within GTA perimeter/just outside of it I'd assume?

Link to post
Share on other sites
5 minutes ago, medigeek said:

Do you know if they're offering mentoring to those new hires as well? 

And the 4 year practice route makes you more eligible for large community hospitals jobs within GTA perimeter/just outside of it I'd assume?

some of the places he listed that you can work with just CCFP are part of the GTA (ie. my Georgetown comment)

Link to post
Share on other sites
3 hours ago, offmychestplease said:

I'm not from ON but just did a quick google search. Georgetown, ON (part of the GTA) is only a 40 min drive from downtown Toronto. So doesn't this mean you could live in downtown Toronto and work as an ER doctor in Georgetown after just 2 years of FM residency? This seems too good to be true lol. There are some cities in Canada where plenty of people's commute to work is longer than that and they live/work in the same city..

Are these ER jobs in these mostly commutable locations from downtown Toronto really coveted by FM grads/doctors (ie are they hard to get)??

Tough question to answer. I'm sure every year there are Pgy2s in fam med in toronto who do not match to the plus 1 EM but still want to work full time ER. They might even have excellent CVs. So of course, there will be some competition. And these ERs I listed are smaller and certainly do not need to hire a new full-time ER staff physician every year. It's not uncommon to locum at multiple of these and similar sites (4-5 shifts/month at each site, over 3 sites), until a full time position develops. Luck and connections plays a role as well. 

Link to post
Share on other sites
3 hours ago, medigeek said:

Do you know if they're offering mentoring to those new hires as well? 

And the 4 year practice route makes you more eligible for large community hospitals jobs within GTA perimeter/just outside of it I'd assume?

No clue about mentoring. If they are, it would probably be informal. For example, making sure you are never providing single coverage for your first year or longer, having colleagues being there to bounce cases off of, helping you with procedures and resuscitations as they come up. I doubt they would have the infrastructure for a formal mentoring or training program. 

More eligible but its certainly all relative and no guarantee. I like to think of it as a hierarchy. If chiefs had their choice, they would prefer FRs over CCFP-EMs via residency over CCFP-EMs via practice, over ccfps with ER experience over CCFPs fresh out of residency. So depends who's hiring and who's applying. Believe it or not, there are FRs working at some of these sites I mentioned above. Not everyone wants an academic practice in a tertiary care centre. These community jobs outside Toronto can actually be quite enticing. 

Link to post
Share on other sites
6 hours ago, Lock123 said:

No clue about mentoring. If they are, it would probably be informal. For example, making sure you are never providing single coverage for your first year or longer, having colleagues being there to bounce cases off of, helping you with procedures and resuscitations as they come up. I doubt they would have the infrastructure for a formal mentoring or training program. 

More eligible but its certainly all relative and no guarantee. I like to think of it as a hierarchy. If chiefs had their choice, they would prefer FRs over CCFP-EMs via residency over CCFP-EMs via practice, over ccfps with ER experience over CCFPs fresh out of residency. So depends who's hiring and who's applying. Believe it or not, there are FRs working at some of these sites I mentioned above. Not everyone wants an academic practice in a tertiary care centre. These community jobs outside Toronto can actually be quite enticing. 

Yeah I meant informally like if you've heard if they provide assistance on certain procedures (ex. complex reductions with sedation). Less so on medical management as I think you should be very competent on the cognitive aspects (including running codes) if you're working in the ED. But some procedures are just tough to get enough experience in during residency. 

Link to post
Share on other sites
6 minutes ago, medigeek said:

Yeah I meant informally like if you've heard if they provide assistance on certain procedures (ex. complex reductions with sedation). Less so on medical management as I think you should be very competent on the cognitive aspects (including running codes) if you're working in the ED. But some procedures are just tough to get enough experience in during residency. 

I would think this will be highly variable. Some colleagues will be friendly and have no problem providing assistance or bringing you in to assist with a procedure. Others will keep to themselves. After all, they're not there to teach. The sites I work at have been extremely collegial but I'd rather not say where for confidentiality reasons. I've also worked at sites where I did not feel very well supported. 

Link to post
Share on other sites
Just now, Lock123 said:

I would think this will be highly variable. Some colleagues will be friendly and have no problem providing assistance or bringing you in to assist with a procedure. Others will keep to themselves. After all, they're not there to teach. The sites I work at have been extremely collegial but I'd rather not say where for confidentiality reasons. I've also worked at sites where I did not feel very well supported. 

Also regarding "complex reductions with sedation", there is absolutely nothing wrong with calling ortho in to do the reduction while you provide the sedation. Might even be able to pick up a few tricks from them. All of the hospitals mentioned would have ortho on home call but available to come in with the exception of maybe Tilsonburg. Would hesitate to work at a place without appropriate backup.

Link to post
Share on other sites
1 hour ago, Lock123 said:

Also regarding "complex reductions with sedation", there is absolutely nothing wrong with calling ortho in to do the reduction while you provide the sedation. Might even be able to pick up a few tricks from them. All of the hospitals mentioned would have ortho on home call but available to come in with the exception of maybe Tilsonburg. Would hesitate to work at a place without appropriate backup.

How about true rural ERs? Quite a few of these, all are mostly FM staffed and none have any back up available (no ortho or anesthesia or essentially anyone lol). 

Link to post
Share on other sites
10 hours ago, medigeek said:

Yeah I meant informally like if you've heard if they provide assistance on certain procedures (ex. complex reductions with sedation). Less so on medical management as I think you should be very competent on the cognitive aspects (including running codes) if you're working in the ED. But some procedures are just tough to get enough experience in during residency. 

I think that's where doing the +1 in EM is super helpful. From the docs I've talked to to, they said the extra year was very intense and they learned more in the +1 alone than in the 2 years prior. Most new FM grads will get 2 core blocks of EM and maybe 2 more if they use electives. They'll usually be treated as the junior resident and won't be the ones leading resuscitations, doing sedations, putting in chest tubes, etc. The +1 residents on the other hand are the senior residents on and get thrown into the more complex cases.

Link to post
Share on other sites
20 minutes ago, gangliocytoma said:

I think that's where doing the +1 in EM is super helpful. From the docs I've talked to to, they said the extra year was very intense and they learned more in the +1 alone than in the 2 years prior. Most new FM grads will get 2 core blocks of EM and maybe 2 more if they use electives. They'll usually be treated as the junior resident and won't be the ones leading resuscitations, doing sedations, putting in chest tubes, etc. The +1 residents on the other hand are the senior residents on and get thrown into the more complex cases.

Absolutely. There’s a reason the plus 1 exists.

Link to post
Share on other sites
9 hours ago, medigeek said:

How about true rural ERs? Quite a few of these, all are mostly FM staffed and none have any back up available (no ortho or anesthesia or essentially anyone lol). 

Generally these tend to be low acuity ERs that see “walk-in” type stuff. But people get sick everywhere. People have aortic dissections on vacation in cottage country and drive drunk in rural Ontario leading to a poly trauma.

I’d personally hesitate to work there for 2 reasons:

1. if the goal is to get experience to do full time ER in a larger hospital, I’m not sure the volume of acuity is there to learn those skills. For example, I’m not sure how many LPs or chest tubes or even intubations, one would get to do per year.

2. when stuff does eventually hit the fan, you might be under resourced. It might be difficult to get consults from specialists or to transfer a patient or to get a ct approved 1 hour away. Your nurses might not be very experienced. Perhaps they don’t know how to start a paediatric iv or do a peds in and out catheter. I worked rural very briefly and would not recommend it. It felt like 99% of patients were there for very low acuity type presentations. And I felt I could not deliver high quality care to the other 1% sometimes due to the limited resources I had available to me. I don’t think it strengthened my ER skills at all. 
 

what I found was these ERs were generally staffed by family docs who lived in the area and had true rural practices there (mix of family, Er, ob, hospitalist, etc). That was not for me as I wanted a full time EM practice in a medium to large sized community hospital.

Of course this is all anecdotal 

Link to post
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...