FM + 1 - what's out there?

[carotidartery]

Hello everyone! I am a current MS1 and first gen soon-to-be doc, so not sure who else to ask and hoping to get some guidance from some seasoned physicians in this community. Primary care/family medicine has always interested me, but I think I would like to specialize or do a +1.  I've heard of emergency and addictions medicine, but what else is out there? And can someone outline how the matching and CARMS process looks like for this, how competitive it is etc -- if data or links exist, please share them! Also what schools provide these different +1 programs (again for residency and possible re-location purposes)? Lastly, any insight on income across the +1 specialities and work/life balance would be superb.

Know this is a bit of a loaded post, but thank you in advance!

[MaudeB]

You can look at the Carms website for the program description/universities offering +1.

https://www.carms.ca/match/family-medicine-enhanced-skills-match/program-descriptions/

Some universities also offer other programs that do not require a carms application and are usually shorter than 1 year. Those programs are usually presented in the enhanced skills programs section on university websites.

 

[mdlifecrisis]

There are the official +1s, and then there are the entrepreneurial family docs who design their own specialization...

I've seen lots of different things, sexual health, lgbt/hiv, pain med, sleep med, hormonotherapy (yes for genderqueer folks, but also yes just for pre-menopausal women), MSK/sports med, minor procedures/vasectomies, youth clinic, abortion clinic, obstetrics, anesthesia, etc.

UofT has some funky +1s.

[MDee2B]

On 9/12/2021 at 6:11 AM, mdlifecrisis said:

There are the official +1s, and then there are the entrepreneurial family docs who design their own specialization...

I've seen lots of different things, sexual health, lgbt/hiv, pain med, sleep med, hormonotherapy (yes for genderqueer folks, but also yes just for pre-menopausal women), MSK/sports med, minor procedures/vasectomies, youth clinic, abortion clinic, obstetrics, anesthesia, etc.

UofT has some funky +1s.

.

[whatdoido]

13 hours ago, MDee2B said:

Hey, at what schools have you seen the sexual health/lgbt/hormonotherapy +1s you mentioned?

it's just family docs advertising their services/clinics at that. they're not official +1s.

[mdlifecrisis]

19 hours ago, MDee2B said:

Hey, at what schools have you seen the sexual health/lgbt/hormonotherapy +1s you mentioned?

There's the LGBTQ+ health R3 at UofT.

https://dfcm.utoronto.ca/enhanced-skills-program-self-directed-pgy3

[medic77]

Alot of people discuss the CCFP-EM +1 program but few mention the +1 anesthesia program. I'm currently applying to it cross country and know several colleagues that have went through it. If you don't enjoy OR anesthesia at all, understandably, don't do it but I would argue it's far more useful than the +1 EM program. This is also pending your primary care program has a decent amount of ER exposure. The reason I find it so enticing is that is gives you far better critical skills in airway and resuscitation than EM and if you have decent rural EM exposure already, it's only a period of time before you 'catch-up' to your +1 colleagues in other ER skills. It also allows you more diversity in your day to day. This is the first year it's being done through CaRMS. I should mention it is very competitive. 

[JohnGrisham]

On 9/13/2021 at 11:17 AM, medic77 said:

Alot of people discuss the CCFP-EM +1 program but few mention the +1 anesthesia program. I'm currently applying to it cross country and know several colleagues that have went through it. If you don't enjoy OR anesthesia at all, understandably, don't do it but I would argue it's far more useful than the +1 EM program. This is also pending your primary care program has a decent amount of ER exposure. The reason I find it so enticing is that is gives you far better critical skills in airway and resuscitation than EM and if you have decent rural EM exposure already, it's only a period of time before you 'catch-up' to your +1 colleagues in other ER skills. It also allows you more diversity in your day to day. This is the first year it's being done through CaRMS. I should mention it is very competitive. 

Might be region dependent, but you definitely can't underestimate the concentrated learning in the +1 EM year, to then set the stage for further early career development while in practice.  I think the "matter of time before you catch up" may be accurate to some extent, but highly variable. There is a reason that the +1 EM year exists. And there is also a reason it still isn't equivalent to full royal college EM, despite many in practice with +1 EM, often "catching up" depending on centre of practice etc.

If you plan on practicing rurally, then yes the additional +1 Anesthesia training is very helpful, and serves a  strong purpose. Not to mention flexibility, and allowing you to offer anesthetic services, which can then attract a local general surgeon to stick around etc.  

One thing to caution is how confident rural trained FM trainees may feel with their "decent amount of ER exposure",  often simply don't know what they don't know(like any other fresh trainee from ANY program), given the different style of rural ERs, and different volumes/case types compared to mid-range centres etc. 

The ability to work with the fellowship in anesthesia is very regional specific as well - generally you are in smaller centres doing less complicated scheduled ORs, but it certainly proves useful for those who are running a rural ED to have enhanced airway skills and able to manage resus's and emergency surgical interventions etc for stabilization.

This commentary is not meant to be antagonistic, but to shine a slightly different light. A plug for Ottawa's +1 in anesthesia, a colleague went through it, and they said it was an excellent training program and they are now in practice in a mid-sized centre with quite a broad scope of practice