Canadian EM Programs

[national]

Hi,

 

I'm in second year med, seriously considering the 5-year emerg route. I'm wondering which schools have historically taken a fair number of residents from other schools provinces (since my own school doesn't have an 5-year program).

 

Also (and this is moreso for discussion really), is there any consensus as to which emerg programs in Canada are the strongest for teaching? I know this would mostly be based on reputation, but I'd be interested to know. Seems like the bigger centres (Toronto, Vancouver, etc) would have the upside in terms of trauma and volume, but you'd also have to fight 10 other students/residents for exposure.

[blinknoodle]

Out-of-town matching stats is available on the carms website (although it seems to have disappeared while the updates for carms 2008).

 

Anyhow, here is an old link.

http://www.carms.ca/jsp/program.jsp?path=../jsp/../program_new/150518

 

As you can see, Dal has only taken out-of-town students between 04-06.

[national]

yikes....one spot per year? rough odds.

[Satsuma]

We just had out career night and the director of the FRCPC program in emerg here at Ottawa basically had the following to say. He said it doesn`t matter what letters are after your name, if you are going to be a good physician you will be one and if you are going to be a bad one you still will be.

 

He said that those who chose the FRCPC route should do so mostly because they are more interested in research or administration. He suggested that if research and admin weren`t of any interest then the CCFP-EM should be strongly considered. He had alot of respect for the CCFP-EM docs and said generally they do very good work. Keep in mind the bulk of physicians working emerg are family physicians and they do a good job and deserve respect.

 

To suggest that having family physicians working emerg is a political patch-job is ridiculous. Family physicians were working in the emerg before emergency medicine was even a specialty. Emergency medicine was only recognized by the RCPSC in 1980 and a 4-year residency created (now 5). The first CCFP-EM program was offered at U of Ottawa in 1979. Thus, the creation of both routes of entry was concurent.

[The_B]

We just had out career night and the director of the FRCPC program in emerg here at Ottawa basically had the following to say. He said it doesn`t matter what letters are after your name, if you are going to be a good physician you will be one and if you are going to be a bad one you still will be.

 

He said that those who chose the FRCPC route should do so mostly because they are more interested in research or administration. He suggested that if research and admin weren`t of any interest then the CCFP-EM should be strongly considered. He had alot of respect for the CCFP-EM docs and said generally they do very good work. Keep in mind the bulk of physicians working emerg are family physicians and they do a good job and deserve respect.

 

To suggest that having family physicians working emerg is a political patch-job is ridiculous. Family physicians were working in the emerg before emergency medicine was even a specialty. Emergency medicine was only recognized by the RCPSC in 1980 and a 4-year residency created (now 5). The first CCFP-EM program was offered at U of Ottawa in 1979. Thus, the creation of both routes of entry was concurent.

 

Well said, and I would add that the EM guys here at Queen's said the same thing about CCFP-EM vs. RCPSC.

[Fred]

I'm going to echo what satsuma said.

 

I was dead set on the FRCPC emerg residency and a CCM fellowship till about 3 weeks ago.

 

My current tutor who is a pneumologist (not sure if that's the word in english, sorry!) and who's going for a CCM fellowship, discouraged me from going the emerg route. Basically, he said that the FRCPC were trained to do research and administer ER departements. CCFP-EM were the "real" clinicians and pretty much equal, skills wise. If I wanted to do clinical work, I would find a better fit doing anesthesia or internal med before the CCM fellowship. Around the same time I sent emails to a few PDs (since there's no emerg faculty in Sherbrooke) and was told the same thing: FRCPC is research and admin focused, don't do it if that's not your thing. For me, it's not so I'm glad I got that info now!

 

If this is what interests you then by all means go for it. To my understanding, all programs are good. Toronto and Ottawa are especially worth looking at in my opinion, but I wouldn't rule out other programs.

[Maxime]

True, EM FRCPC physicians are trained in administration and research, but there's also a big emphasis on medical education, and you have the possibility after the FRCPC route to do a fellowship in emergency pediatrics, prehospital care, etc..., which is not the case after CCFP-EM.

 

If you plan on working anywhere else than in a big metropolitan arean, than CCFP-Em is definitely the way to go. But if you want to work in the city, I think FRCPC can be quite interesting.

[Ollie]

I'm on my emerg rotation right now at a community hospital and every doc I work with is a CCFP-EM. When I did a rural ER elective, most of the doc didn't even have the EM fellowship. Most ERs except "major teaching hospitals" are run by family docs, so to say their training is inadequate is unfair.

 

I do agree that many people go in to family medicine with no intention of having an office practice, and given the shortage, that's something we really can't afford. But I think a lot of people are not interested in the FRCPC program because they don't want to have an academic/administrative career, or because they want the option to have a office practice later on in their career. I think the EM program definitely needs to be expanded without taking away regular family medicine positions, but I'm not too sure how!

[national]

I was dead set on the FRCPC emerg residency and a CCM fellowship till about 3 weeks ago.

 

It's funny how often we can change our residency choices!

 

I think I've come to mostly the same conclusion after talking with a few of the EM docs I've been working with. Why do the 5 year route if you're mostly just interested in the clinical aspect? I can see it being a little more daunting, going into practice in 3 years instead of 5, but everyone says that the docs are equally competent clinically. And I have ABSOLUTELY no interest in research or administration. Teaching is something I'm interested in, but I think there's lots of opportunities for the CCFP(EM) docs to teach (at least there is at my school).

 

 

I think maybe it's a knee-jerk reaction for med students to want to do the "elite" program (ie. harder to get into). We're just hypercompetitive.

 

So now I have a new set of questions...what would you look for in a good CCFP(EM) program? Are there any family residency programs that are a good preparation for this route? In my mind, I'd see a rural family med residency as being a great opportunity to see/do a lot, preparing you for the emergency fellowship. Also, I wonder if it would be beneficial to do your 3rd year training at a school that DOESN'T have the FRCPC program - so as not to have a glut of residents all vying for the same procedures/patients. Any thoughts?

 

I do agree that many people go in to family medicine with no intention of having an office practice, and given the shortage, that's something we really can't afford.

 

This is another great point...is it "dishonest" to go into a family medicine residency with the implication that you're definitely going for the 3rd year EM? Seems like you're using the residency program as a means to an end, though I suppose many CCFP(EM) docs may set up office practices later in life.

[extrachromasome]

I agree that the CCFP-EM is a great way to go. However, I would add that the standard of care is shifting towards more and more specialisation, and higher levels of training. While CCFP-EM docs can currently find jobs in urban centres, this may not be the case 15 years from now.

[ploughboy]

As I understand it, there are two ways you can sit the ccfp-em exam; as a "residency eligible" candidate, or as a "practice eligible" candidate already having a CCFP designation. If you do 400 hours of ER work per year for 4 years you're eligible to sit for the exam. The trick would be to get a job in an ER in the first place without having any formal emergency training. Entirely possible in the periphery, but not so likely in a major academic centre.

 

http://www.cfpc.ca/English/cfpc/education/examinations/emergency%20medicine/default.asp?s=1

 

As for the history of the two streams of emergency medicine training in Canada, here's a quick overview...

 

http://www.cmaj.ca/cgi/reprint/168/12/1549.pdf

[brownie99]

Hey all,

 

Having spoken to several ER docs about this question, it seems that the CCFP-EM's are considered equivalent to the FRCPC grads within 5 years post-residency. However, several doctors (incl a director of a tertiary centre ER) seem to think that the CCFP-EM's are going to be phased out of major urban centres and pushed to rural areas during our career, much like is happening with CCFP-Anesthesia. Food for thought.

[national]

Hey all,

 

Having spoken to several ER docs about this question, it seems that the CCFP-EM's are considered equivalent to the FRCPC grads within 5 years post-residency. However, several doctors (incl a director of a tertiary centre ER) seem to think that the CCFP-EM's are going to be phased out of major urban centres and pushed to rural areas during our career, much like is happening with CCFP-Anesthesia. Food for thought.

 

how much of a possibility is this really? if they're only graduating ~50 FRCPC docs a year, how can they possibly staff all the urban centres?

 

when we talk about "urban centres", are we really just talking about large, university based trauma centre hospitals in the core of cities like Vancouver, Montreal, and Toronto? or does this "phasing out" apply to "smaller" (that's certainly a relative term) major hospitals (eg. halifax, kingston, etc)?

 

i don't see a personal interest in working in the huge centres like sunnybrook in toronto - but i can certainly imagine working in a mid sized hospital with a decent range of resources. and from what i've heard from the docs here, those hospitals are almost exclusively staffed by CCFP(EM), and will be for the near future. or have i been mislead?

[zc1]

...he said that the FRCPC were trained to do research and administer ER departements. CCFP-EM were the "real" clinicians and pretty much equal, skills wise. If I wanted to do clinical work, I would find a better fit doing anesthesia or internal med before the CCM fellowship...

There's a lot of misinformation in this thread.

 

The above quote is simply not true. If you would like to know what the Royal College-trained emerg physicians are trained to do then I suggest speaking to one of them, and not to a pulmonologist/pneumonologist. Same goes for the opposite scenario. Have a look at the curriculum from any of the Royal College-accredited emergency medicine programs in the country and you'll see a maximum of 2 months of dedicated "administration" time and a similar amount of dedicated "research" time. Yes, in the course of your training you will learn something about emerg dept. adminstration and about research, just as in your internal medicine training you'll learn a bit about office practice management. It's completely erronious to say that this is the focus of the training. In my program we spend 3 months in ICU, 3 months in CCU, 2 months in peds ICU and 3 months in general internal medicine. In addition to this, you have more than 15 months of elective time that you can further devote to ICU/ICM training if desired. At the present time, no surgery, anesthesia or internal medicine program in the country matches that. The Emerg route to CCM/ICU is a relatively new one. The majority of intensivists still come from Internal Medicine, Surgery or Anesthesia backgrounds, but this is starting to change. If you look at Emerg programs such as those in Winnipeg and Edmonton you'll see that CCM is becoming a very popular fellowship among Royal College Emergency Medicine trainees.

 

Regarding Family Medicine + 1 year Emerg: There's no need to feel guilty about intending on taking this route for the sole purpose of practicing emergency medicine. Programs fully expect some people to be interested in the extra training and not interested in family practice. I've been through the process and know first-hand that they don't think poorly of people who apply to Family Medicine with the intent of doing a +1 year of emerg. The spots are there because there's a need for emerg physicians. Just be honest about it. It will probably be obvious from your choice of electives and extracurricular work, anyhow.

 

Regarding 5-year "research + admin focus": Again, this is inaccurately presented. The Royal College Emerg programs were increased from 4 years to 5 years in duration in order to allow more time for residents to develop their interests in specialty areas of Emerg Medicine. These have traditionally been referred to as "academic emergency medicine," but this is not synonymous with "research or admin." Specialty interests include trauma, intensive care medicine, emergency medical systems, administration, research, medical education, toxicology, sports medicine, wilderness medicine, the list goes on. Essentially, graduates from Royal College emerg programs are expected to have some other area of special expertise, such as those I've listed. For whatever reason, this always gets interpreted as meaning "research or administration."

 

Regarding 5-year (Royal College) vs 2+1 (CCFP-EM) training: Graduates are *not* equal with respect to competence in Emergency Medicine at the end of their training. Would you really expect them to be? The general consensus, though, is that by 5-10 years out of training the CCFP-EM trained physicians are on par with their Royal College counterparts. I'll also note, here, that in the USA there are no 5-year programs. There are only 3- and 4-year programs. Have a look at this site for more info -- http://emramatch.org/.

 

Regarding Hirability: This varies by region of the country. No generalizations can be made. Ask about hiring practices in whatever city/cities you're interested. It is true that in many towns and smaller cities the emergency departments are staffed by family physicians who don't have +1 training (i.e. CFPC and not CCFP-EM). No real surprise there. It's hard enough to get GPs in many towns. They're not going to insist that their emergency departments be staffed by "specialists" in emergency medicine.

 

General Trends: Who knows? The suggestions that urban centres may move towards favouring Royal College-trained physicians in future rounds of hiring may be true, but I really don't know. Ten years ago most programs also didn't really care if you had research experience, but now that has changed. Some might say that, with the future being so uncertain, you're better off over- than under-qualified. Times change. In the grand scheme of things, two extra years (Royal College vs 2+1) really isn't that much...and this is coming from someone who has already completed 12 years of University training (not including residency).

 

If all you want is to be an emerg doc then both routes will suffice, but one would make you more marketable in that role. Both offer some flexibility in your future practice. Please don't rule out the 5-year program because you're not interested in "research and administration." That's really not the focus of the training and anyone who tells you otherwise without qualifying their statement is spreading misinformation. I've also heard the program director in Ottawa speak (on the CaRMS tour) and he was very careful to point out that they do not expect applicants to their program to be dead set on research careers or on research as a major focus during their training. This is despite their program's reputation as one that is very strong insofar as training in research methodology and output of clinical EM primary studies are concerned.

 

I've probably missed some points with respect to which I had wanted to comment, but that's alright. It's not like I haven't already said enough.

 

ZC1