Ask questions about emergency medicine here

[JohnGrisham]

5 hours ago, amerus12 said:

Thank you for all of your responses! I’m a third year medical student and very interested in EM. I’ve been grateful to be able to pick up 1-2 ER shifts per week this last year dispute COVID - my third year is rural. When I’m in the ED, it feels like I’m ‘home’ and a 10 hour shift passes in 5 minutes. I don’t have any experience with tertiary ED and my preceptors are FM ( not plus 1 ) with one 5 year doc.

For the 5-year EM docs here, I was wondering what you picked as your interest area ( e.g. medical education, sports Med, transport, mass casualty, etc. ). is this included in the fourth year or is it a fellowship after? Did you do anything in your clerkship to show your interest?

I’ve read a bit about addictions medicine sub specialty of EM ( but in the states ). Can Canadian 5 year EM docs do this and have an out patient clinic as well as EM? 

Thank you!

In general with a 5 year FRCPC you won't be doing outpatient work in Canada.  You will be working in an emergency department of some sort mostly, or some other venture on private contract work ( such as MGM etc).

This is a main difference for +1 vs 5 year; FM+1 have flexibility to do outpatient work if they get burnt out by EM work. 

 

[SillyPanda]

On 4/2/2021 at 8:21 AM, amerus12 said:

Thank you for all of your responses! I’m a third year medical student and very interested in EM. I’ve been grateful to be able to pick up 1-2 ER shifts per week this last year dispute COVID - my third year is rural. When I’m in the ED, it feels like I’m ‘home’ and a 10 hour shift passes in 5 minutes. I don’t have any experience with tertiary ED and my preceptors are FM ( not plus 1 ) with one 5 year doc.

For the 5-year EM docs here, I was wondering what you picked as your interest area ( e.g. medical education, sports Med, transport, mass casualty, etc. ). is this included in the fourth year or is it a fellowship after? Did you do anything in your clerkship to show your interest?

I’ve read a bit about addictions medicine sub specialty of EM ( but in the states ). Can Canadian 5 year EM docs do this and have an out patient clinic as well as EM? 

Thank you!

Yes, addictions medicine is becoming increasingly popular amongst 5 year grads. I know some ED docs who do clinic (mostly rapid access addictions clinic) and also do inpatient addictions consult service, in addition to regular EM practice.

Some people did do this as a fellowship year during residency, however, with the transition to the CBD residency curriculum, most of your "area of interest" time is now during your R5 year (since R4 is now the Royal College year). This makes it a bit more challenging to do a full 1 year fellowship during that time (as you also need to apply for jobs, work on transitioning to practice, etc..). It's still a bit unclear how this will work.

There are still a broad array of interests that people choose. Ultrasound, trauma, sports med (which can also be clinic based), med ed, transport medicine, PEM, geriatrics, resuscitation, etc..

[MDwannabe02]

Incoming FM PGY1 in a rural program here. Just wondering if somebody could speak to which schools are more likely to take incoming PGY3s to EM from outside their own FM programs? Planning to apply broadly (best shot likely at my home school), but would like to focus away elective(s) on programs most likely to take applicants from other schools. I've heard that U of A is pretty good for taking outside applicants

[shikimate]

Our center is having a ton of difficulty recruiting EM, the department is resorting to pleading with the FM group to provide ER coverage. Where are all the EM grads???

If anyone here (FM, FM+EM, EM) wants to come work message me anytime.

[rogerroger]

On 4/2/2021 at 1:03 PM, JohnGrisham said:

In general with a 5 year FRCPC you won't be doing outpatient work in Canada.  You will be working in an emergency department of some sort mostly, or some other venture on private contract work ( such as MGM etc).

This is a main difference for +1 vs 5 year; FM+1 have flexibility to do outpatient work if they get burnt out by EM work. 

 

 There are opportunities out there for outpatient work with an FRCPC. Within my practice group alone I know FRCPC docs doing sports medicine, pain medicine, addictions, aerospace medicine, etc, and various types of procedural work within clinics. I count myself among this group. They are all FRCPC trained. 

I would say this is becoming increasingly more common, particularly amongst those who finished residency within the last ten years. Now that I am coming up on five years post residency, I find myself actively actually encouraging others who are newly minted staff to consider “side gigs” to leverage your training outside of the emergency department. I think this is key for many ppl in order to fully enjoy a long-term career within emergency medicine, to maximize one’s potential to expand, and to make your life more interesting.

[JohnGrisham]

13 hours ago, rogerroger said:

 There are opportunities out there for outpatient work with an FRCPC. Within my practice group alone I know FRCPC docs doing sports medicine, pain medicine, addictions, aerospace medicine, etc, and various types of procedural work within clinics. I count myself among this group. They are all FRCPC trained. 

I would say this is becoming increasingly more common, particularly amongst those who finished residency within the last ten years. Now that I am coming up on five years post residency, I find myself actively actually encouraging others who are newly minted staff to consider “side gigs” to leverage your training outside of the emergency department. I think this is key for many ppl in order to fully enjoy a long-term career within emergency medicine, to maximize one’s potential to expand, and to make your life more interesting.

Definitely becoming more common! Especially with younger trainees willing to do further training/fellowships open to royal college trainees in other areas. It definitely is a great way to help prevent burn out. Some that I have seen recently were pain fellowship, palliative  and addictions.  Most of the time(jurisdiction dependent), it does require further training however(or if you can build the extra fellowship into the 5 year base program etc). 

[Redpill]

Can someone explain the point of the 5th year of the FRCP program now if you finish the Royal College exam in the 4th year, and can't even complete a 1 year fellowship due to other competing things taking up your time?

Is it free labour? Historical? Seems like a waste to me...

[zxcccxz]

1 hour ago, Redpill said:

Can someone explain the point of the 5th year of the FRCP program now if you finish the Royal College exam in the 4th year, and can't even complete a 1 year fellowship due to other competing things taking up your time?

Is it free labour? Historical? Seems like a waste to me...

Would love to hear the answer to this as well... seems kinda crazy to me that EM is 3 years in the US and 5 years here... especially when you can do a one-year fellowship as an FM and have the same scope of practice & renumeration...

[cookie_m]

Any recommendations to be competitive for +1 in EM, aside from doing electives in EM? 

[2hopeful]

On 9/29/2021 at 10:55 PM, rogerroger said:

 There are opportunities out there for outpatient work with an FRCPC. Within my practice group alone I know FRCPC docs doing sports medicine, pain medicine, addictions, aerospace medicine, etc, and various types of procedural work within clinics. I count myself among this group. They are all FRCPC trained. 

I would say this is becoming increasingly more common, particularly amongst those who finished residency within the last ten years. Now that I am coming up on five years post residency, I find myself actively actually encouraging others who are newly minted staff to consider “side gigs” to leverage your training outside of the emergency department. I think this is key for many ppl in order to fully enjoy a long-term career within emergency medicine, to maximize one’s potential to expand, and to make your life more interesting.

Are there many opportunities to work part time or 0.75 FTE? And how many hours/shifts would that equate to in a month?

[fmgunner]

How is the EM job market nowadays? I see from previous threads it used to be good, but heard anecdotally that it has been more challenging recently with new grads, in particular for more desireable locations like the GVA. Especially last year, I heard none of VGH's FR residents were hired at VGH, and they all had to scramble to find other jobs in the area.

[Lock123]

On 3/8/2022 at 5:05 PM, fmgunner said:

How is the EM job market nowadays? I see from previous threads it used to be good, but heard anecdotally that it has been more challenging recently with new grads, in particular for more desireable locations like the GVA. Especially last year, I heard none of VGH's FR residents were hired at VGH, and they all had to scramble to find other jobs in the area.

Pretty good in GTA. FRs and +1s in great shape and plenty of opportunities without plus 1 if willing to go outside Toronto 45 mins-1hr. Don’t know GVA very well though.

[no-name]

Great thread! I also have a question. Is it possible for a family physician to do part time EM (e.g. 2 shifts) and part time FM office work (e.g. 2-3 days/week) ? In that case, is it still better to do the CCFP-EM training in order to get the proper training/job position ? or just taking a lot of electives in EM during residency would be sufficient?

[indefatigable]

5 hours ago, no-name said:

Great thread! I also have a question. Is it possible for a family physician to do part time EM (e.g. 2 shifts) and part time FM office work (e.g. 2-3 days/week) ? In that case, is it still better to do the CCFP-EM training in order to get the proper training/job position ? or just taking a lot of electives in EM during residency would be sufficient?

I've only seen part-time EM in very specific situations - e.g. more rural/small town sometimes with and sometimes without the CCFP-EM designation.    I don't think the +1 would be necessary, but wouldn't hurt either.  I think maintaining competency in both domains could be challenging over time.  

[MDwannabe02]

5 hours ago, no-name said:

Great thread! I also have a question. Is it possible for a family physician to do part time EM (e.g. 2 shifts) and part time FM office work (e.g. 2-3 days/week) ? In that case, is it still better to do the CCFP-EM training in order to get the proper training/job position ? or just taking a lot of electives in EM during residency would be sufficient?

I’m a resident in a rural family medicine program (PGY2), but I do many off-service rotations at a regional semi-academic site that I will be doing the EM year at next year. At my rural site (town of ~20,000) there are both EM and non-EM trained docs in the ED. I have seen excellent emerg docs with and without the extra EM training. If you want to work rurally and if a department is in need, they will likely hire you. 
 

Your comfort level after 2 years of FM training is highly variable though, so that’s entirely up to you if you want to pursue EM training for that reason (programs are +++competitive though, so for sure no guarantees). I myself wouldn’t feel comfortable, but many do. I also plan to do EM full-time, so I have other reasons to go the +1 way. If you do a bunch of EM and ICU electives, you may feel more ready to do some EM on the side of your family practice. Or just jump right in - I’ve talked to plenty of docs who have done that too

[no-name]

Thank you for the info! It is not the first time that I hear that people who do FM+EM generally work only in EM. I understand that some people went this route because they are solely interested in EM, but I'm pretty sure that others like me enjoy both FM and EM and would like a mix of both in their practice. As you said, in rural settings, it is half-half sometimes. Why not in the city? Is it because the positions available are only offered full time?

Also, could someone please elaborate on the comment about 'maintaining competency would be more challenging'? To me, a lot of primary care and EM overlap. I understand that in EM, you have to be comfortable in acute settings/running codes/etc. and in FM, you must keep track on guidelines/follow-ups but I feel that most of the knowledge is either easily accessible or overlaps. Please correct me if I'm wrong. 

Would it be easier if I found a niche within my FM practice? For example, I am very interested in migrants health (that is also why I'd prefer staying near a city).

[indefatigable]

1 hour ago, no-name said:

Thank you for the info! It is not the first time that I hear that people who do FM+EM generally work only in EM. I understand that some people went this route because they are solely interested in EM, but I'm pretty sure that others like me enjoy both FM and EM and would like a mix of both in their practice. As you said, in rural settings, it is half-half sometimes. Why not in the city? Is it because the positions available are only offered full time?

Also, could someone please elaborate on the comment about 'maintaining competency would be more challenging'? To me, a lot of primary care and EM overlap. I understand that in EM, you have to be comfortable in acute settings/running codes/etc. and in FM, you must keep track on guidelines/follow-ups but I feel that most of the knowledge is either easily accessible or overlaps. Please correct me if I'm wrong. 

Would it be easier if I found a niche within my FM practice? For example, I am very interested in migrants health (that is also why I'd prefer staying near a city).

It's more competitive to get a job in most cities, so FM+1 is often a minimum requirement - i.e. having more experience/education in EM is a necessary qualification.  Otoh, in more rural settings, the demand for coverage is higher than the pool of EM certified applicants so only having FM, with some EM experience, may be sufficient to get a job.  

There's definitely some overlap between the FM and FM/EM.  And, right after residency, it's probably easier to split time in both outpatient and ER because knowledge in both areas can be more up to date (supposing one has some comfort in EM).  However, as time goes along, guidelines/medications for outpatient FM like chronic diseases management, screening, women's health.. can change which have less utility in an ER setting.  Likewise, managing acute patients, interpreting imaging.. and maintaining code/procedural competency is harder to do in an outpatient setting.  So, it's obviously possible and many docs are able to do it, but it requires more work as the scope of practice is larger.  And transitions in both directions are possible, but can take time.  

So, I think it may be possible, but most niches in FM practice would be easier to stay in the city rather than part-time EM (rural of course quite different).  

[frenchpress]

@no-nameI agree with the others that the majority of EM+1 I have worked with in large urban areas only do EM (I've trained in BC/AB), but I have met several working in midsized/community hospitals who do a mix of both. Usually it's EM plus some kind of focused practice (hospitalist, sports med, etc.). In rural areas in BC/AB it is very common to find docs doings both EM and some general FM or other FM area of focus (obs, anesthesia, etc).

As others have said, in places with a lot of need it can be easy to get a position with just FM. But in my experience I would say that having the EM+1 is also not uncommon in smaller or rural hospitals, particularly among new grads and in more desirable practice locations. To some extent because that's where the jobs are, but also because I think newer grads increasingly recognize that it's hard to gain enough experience in a 2-year FM residency to feel competent running a small ED on your own (where you have little to no back up), and there's nothing wrong with getting some extra training to feel comfortable/competent.

I did ICU and 5 blocks of EM in FM residency (not including another ~2.5 blocks worth of rural and extra community EM shifts throughout) and while you'd think that would be enough experience to go on to feel comfortable working rural EM as I intend, I had such a white cloud that I saw literally a handful of airway emergencies/codes/significant resuscitations the entire time. I've also met a number of FM docs who used to do rural EM, and then stopped, because they felt like they were in over their head when shit hit the fan and they had no RT/anesthetist/surgeon to call and help them. Those two things combined were a large motivator in my decision to do a +1.

[lolita3627]

Hello everyone !

I'm a 2nd year med student in quebec and interested in EM. I initially was pursuing FRCPC, but the whole unpredictable, irregular shift work with seemingly no way out during your carrer is kind of scaring me away.

I would totally do CCFP-EM, but I just don't like the idea of doing FM for 2 years and not being guaranteed the fellowship. I would love to work both outpatient and the ER, so it would really be ideal. I think I could like FM work a few times a week, but having at least one or two days a week of ER is my priority. I'm totally fine with a some FM type work every week, but I really don't want to never do the ER.

That is my concern. I have already figured out the pay aspect and the job prospect aspect.

My only concern is the lifestyle with FRCPC. So I have 3 questions:

- What are some ways to get out of irregular shift work as a full time FRCPC ? I'm talking about research, teaching, clinics and stuff like that. How much do they help giving you a more reasonable schedule ?

- How many of the 12-15 shifts/mo are night/evening ? Does anyone have a typical FRCPC attending schedule they could post here ?  How much time in advance do you get your schedule ?

- How does vacation work as a FRCPC vs CCFP-EM ? How much time can you approx take off, will you be able to take that time approximately when you want it to be, or do you have to settle ?

Thanks

[frenchpress]

1 hour ago, lolita3627 said:

 

- What are some ways to get out of irregular shift work as a full time FRCPC ? I'm talking about research, teaching, clinics and stuff like that. How much do they help giving you a more reasonable schedule ?

- How many of the 12-15 shifts/mo are night/evening ? Does anyone have a typical FRCPC attending schedule they could post here ?  How much time in advance do you get your schedule ?

- How does vacation work as a FRCPC vs CCFP-EM ? How much time can you approx take off, will you be able to take that time approximately when you want it to be, or do you have to settle ?

Thanks

Maybe there is some consistency in Quebec, but in AB / BC where I’ve worked I would say it’s very difficult to give a generalized answer to these questions. Every department is different and it varies on a number of factors - there is no ‘typical schedule’, nor would I say there’s a typical time frame when scheduling starts (can be a month to a few months).

Number of evening shifts you’d be expected to do depends on the size of the department (number of people working in it), the total number of shifts, and the length of those shifts. For example, some departments do half overnights (e.g., 11pm- 4am and 4am - 11am or something like that). In a large department that has multiple docs on any given shift / lots of overlap, you may do a handful of evenings or overnights a month, but it also depends on what you define as evening (e.g, you might have several different shifts each month that go until 6pm, 9pm, midnight, 2am, 5am etc.). In a rural community with only 2x 12hr shifts per day, you might do 5-6 overnights a month or more, but you only have overnight or day to worry about. It also depends on whether you’re full or part time. 

If you work in a department where certain people really like working overnights (these people exist), you may be able to get people to swap with you and you’ll rarely have to do them. Or if you work in a department with seniority rules, you may have options to take ‘less desirable shifts’ after a number of years.

The answer is the same for how much vacation time you can take off and how flexible scheduling is. It’s department and resource dependant, and in my experience not dependent on whether you’re FRCPC or FM+1.  The community I am working in right now, some of the docs take 3-4 months off a year. I’ve worked in other departments where people get a guaranteed month ‘sabbatical’ where they can go work other places. Etc etc. 

If you’re really unsure about the lifestyle but know you want to do EM, I recommend you try to do core / elective rotations in hospitals you imagine you’d actually like to work at. And ask the docs you’re working with these questions. You’ll get a much better sense of what the different practice styles are like and what options people have in your own medical community than from the generalized answers we can give you. 

[gangliocytoma]

On 2/26/2023 at 1:03 PM, lolita3627 said:

Hello everyone !

I'm a 2nd year med student in quebec and interested in EM. I initially was pursuing FRCPC, but the whole unpredictable, irregular shift work with seemingly no way out during your carrer is kind of scaring me away.

I would totally do CCFP-EM, but I just don't like the idea of doing FM for 2 years and not being guaranteed the fellowship. I would love to work both outpatient and the ER, so it would really be ideal. I think I could like FM work a few times a week, but having at least one or two days a week of ER is my priority. I'm totally fine with a some FM type work every week, but I really don't want to never do the ER.

That is my concern. I have already figured out the pay aspect and the job prospect aspect.

My only concern is the lifestyle with FRCPC. So I have 3 questions:

- What are some ways to get out of irregular shift work as a full time FRCPC ? I'm talking about research, teaching, clinics and stuff like that. How much do they help giving you a more reasonable schedule ?

- How many of the 12-15 shifts/mo are night/evening ? Does anyone have a typical FRCPC attending schedule they could post here ?  How much time in advance do you get your schedule ?

- How does vacation work as a FRCPC vs CCFP-EM ? How much time can you approx take off, will you be able to take that time approximately when you want it to be, or do you have to settle ?

Thanks

As a 2nd year student I think you still have lots of career exploration ahead of you. I would keep an open mind and talk with staff at your institution to see what things are like there. I can't provide a Quebec specific answer. also I wouldn't say there is no way out of a career in FRCPC - there are lots of fellowship and additional training options for practice outside the ED. It looks like you need to do a bit more research into this.

I don't think looking at lifestyle from a perspective of CCFP EM vs FRCPC is the right way to do it. Your lifestyle will depend on how many clinical shifts you decide to take on. I would say the lifestyle of full-time FP with an average sized practice is probably busier than that of a full time ERP. Yes you may have defined hours, but you have a lot of work that follows you outside those hours such as catching up on charting, sending referrals, inbox, forms, etc. The benefit of EM is you can work as much or as little as you'd like (within specific limitations based on the group size and where you work) and you leave your work at work. 

I wouldn't necessarily say the shift work is unpredictable. More and more departments are moving towards metricaid based scheduling where you provide your preferences and availability. The flexibility there would depend on how big the group is and how many shifts and overnights, weekends, etc. you'd be required to cover. If you consider the average full time EM doc working 12 shifts a month, that still leaves you with lots of free time to be with family, do errands, pursue your hobbies, etc. Yes you sometimes require planning your events and booking things off ahead of time. I've also found that if something comes up last minute depending on the collegiality of the group, shift swaps are almost never an issue. From my chats with staff in my department, younger staff actually prefer the nights bc it allows them to sleep during the day when their kids are at school.

Most practicing physicians don't truly get "vacation" - you basically chose to not work for a specific period of time. This may be an exception in academia. In EM you have the option of stacking your shifts together to forgo or lessen the loss of income. Please not that as a family doc taking vacation usually means you have someone covering for you, otherwise you will be having to stay on top of inbox items while you're away; both to prevent a backlog of work and secondly to ensure no critical findings on investigations you ordered go missed.