Emergency medicine work week in a rural area

[Guest copacetic]

i am interested in practicing emergency medicine in a rural area. any idea what the average work week is? is it possible to work 3 12 hour shifts a week? i am concerned that in rural areas there would not be enough physicians around to allow for this.

[dalmedical12]

Hmmm...how rural do you want to get? You can find Regional centers that are staffed by real E.R. docs that I would consider rural...but then you can also find collaborative practices in the maritimes where theys taff an E.R. of a small town with family physicians still.

[White-Tiger]

Hmmm...how rural do you want to get? You can find Regional centers that are staffed by real E.R. docs that I would consider rural...but then you can also find collaborative practices in the maritimes where theys taff an E.R. of a small town with family physicians still.

 

 

Uhm...nationwide most of the ER doctors are "still" family doctors...

[leviathan]

Almost all of rural BC hospital ERs are staffed by FPs without even the CCFP-EM training. Some of the ones I've run into are pretty amazing, others I wonder how they have kept their medical licenses for so long.

[JewelLeigh]

Hmmm...how rural do you want to get? You can find Regional centers that are staffed by real E.R. docs that I would consider rural...but then you can also find collaborative practices in the maritimes where theys taff an E.R. of a small town with family physicians still.

Wow...lol..."real E.R. docs" - better not let the CFPC family medicine-trained docs who practice full time emerg hear you say that!

[White-Tiger]

Wow...lol..."real E.R. docs" - better not let the CFPC family medicine-trained docs who practice full time emerg here you say that!

 

No kidding, as someone who wants to go the 2+1 EM route, this makes me cringe...

[JewelLeigh]

i am interested in practicing emergency medicine in a rural area. any idea what the average work week is? is it possible to work 3 12 hour shifts a week? i am concerned that in rural areas there would not be enough physicians around to allow for this.

I haven't worked in an ER that has only 12 hour shifts. Some have 12 hour over-night shifts, but shorter shifts with some double-coverage during the days. Others have 8 hour shifts only.

 

Either way...if you wanted to do 36 hours per week of shifts in a rural ER, I am sure most, if not all, rural ERs would welcome you with open arms. Because it is shift work which randomly changing hours, and because the shifts can be pretty stressful, my experience (both rural and urban) has been that most fulltime ER docs do an average of about 12-16 shifts a month - which is in line with what you seem to desire.

[Satsuma]

No kidding, as someone who wants to go the 2+1 EM route, this makes me cringe...

 

I get the impression for the original "offending" post that the writer was refering to family med docs without the +1

[White-Tiger]

I get the impression for the original "offending" post that the writer was refering to family med docs without the +1

 

Well I'm still undecided as to whether I wanna do the +1 or just work for 4 years in an ER then take the EM test

[r_u_ratty]

Hi Satsuma... I am not a doctor.. but a user of the med system.. and I live in a very rural area in northern B.C. Let me tell you, you work very long shifts, and you would be very lucky to only work 3 - 12 hour shifts. My northern community we have had to fly out of here for orthopedic surgery due to no specialists, in record snow storms, and the worst road conditions you could imagine. Most of our new docs are from South Africa and rotate every 6 mos due to the heavy stressful hours and demands. You would really have to luv the north in BC to work here, and put up with alot of... we do not have the resources or staffing or beds. Then on the other hand if you go to Prince George... that is not so remote, they are a regional center, and have full resources... you go any further than PG, you are in my territory .... and expect the unexpected and no resources, or specialits for consult.. have vancouver or PG on speed dial.... Speaking from a mom, who had a child diagnoised with cancer (wilms tumour) at age 1.

[Satsuma]

Well I'm still undecided as to whether I wanna do the +1 or just work for 4 years in an ER then take the EM test

 

Interested in your thoughts on this. We all know that in the big debate of 2+1 vs 5 years the argument about how if you don`t want to work in an urban centre then the 2+1 is fine...more than enough even seeing as many emerg departments are staffed with FPs who did not specialise in emerg.

 

I do not plan on working in a rural community. But I often think really it should be the 5 years in the rural places since they have no access to specialist consults like in urban tertiary centres. I mean if it were me and I was in the middle of nowhere...no anesthesia to call for help for that difficult intubation etc. I would want that extra training.

 

I can`t imagine thinking I would be the sole emerg doc in some remote hospital with just the experience you get in family med residency. I believe at most it is 8 weeks of emerg in those 2 years? It is true the argument can be made that tertiary centres see higher acuity cases....but still.

 

So while it is true that you might not need the +1 to get a job, don`t you want it just for yourself? Just curious to hear someone else's line of thought on the issue.

[leviathan]

Interested in your thoughts on this. We all know that in the big debate of 2+1 vs 5 years the argument about how if you don`t want to work in an urban centre then the 2+1 is fine...more than enough even seeing as many emerg departments are staffed with FPs who did not specialise in emerg.

 

I do not plan on working in a rural community. But I often think really it should be the 5 years in the rural places since they have no access to specialist consults like in urban tertiary centres. I mean if it were me and I was in the middle of nowhere...no anesthesia to call for help for that difficult intubation etc. I would want that extra training.

 

I can`t imagine thinking I would be the sole emerg doc in some remote hospital with just the experience you get in family med residency. I believe at most it is 8 weeks of emerg in those 2 years? It is true the argument can be made that tertiary centres see higher acuity cases....but still.

 

So while it is true that you might not need the +1 to get a job, don`t you want it just for yourself? Just curious to hear someone else's line of thought on the issue.

 

I think you are right that the rural centres should have 5 years of training, but at the same time they are limited in number and also more difficult to justify being out in rural towns with low volumes of high acuity cases. The rural family medicine programs usually train the FPs to be quite competent in a much larger scope of practice than an urban FP, which is the only save for them. The FPs I work with who run the emerg/urgent care centres don't have the CCFP-EM year but they are mostly all pretty good at what they do. I have however heard of some interesting cases where I think some of them definitely forgot their ACLS training...one post-arrest patient who was bradycardic and the doc was asking US if he should push epinephrine.

[coastalslacker]

I think you are right that the rural centres should have 5 years of training...

 

Really? Five years? EM is three years in the US and they seem to do just fine. I think EM is a great specialty, however, not sure why it needs to be a 5 year residency. A quick look at the carms site is pretty interesting-if these programs were to cut back on "research", "administration" and the gazillion electives, they could get it done in 3 or 4 years. I've often heard U of A mentioned as one of the top emerg programs in Canada. Their schedule involves 24 weeks of electives in the first 4 years and a 5th year that is entirely electives.

 

That's not even considering the fact that an average work week while on service is 32 hours over 4 shifts.

[The_B]

I've heard on two separate occasions (once a resident, and once an attending) that the 5 year is meant for those who want to "advance the field of emergency medicine". They basically said, if your goal is to be a clinician, then there isn't much point to doing the 5 year.

[leviathan]

Really? Five years? EM is three years in the US and they seem to do just fine.

What I meant to say was that they should do the *longer* option, not that they necessarily need to do 5 whole years. When they do CCFP-EM you get maybe a few weeks of EM in your FM residency, and then one actual year dedicated to EM (although most programs have several weeks in anaesthesia and other specialties).

[Satsuma]

Really? Five years? EM is three years in the US and they seem to do just fine. I think EM is a great specialty, however, not sure why it needs to be a 5 year residency. A quick look at the carms site is pretty interesting-if these programs were to cut back on "research", "administration" and the gazillion electives, they could get it done in 3 or 4 years. I've often heard U of A mentioned as one of the top emerg programs in Canada. Their schedule involves 24 weeks of electives in the first 4 years and a 5th year that is entirely electives.

 

That's not even considering the fact that an average work week while on service is 32 hours over 4 shifts.

 

Emergency medicine is a newish specialty and I think still working out the issues with having 2 streams of entry. I believe we are the only country to have this issue. But the change from the 4 year FRCP to the 5 year happened specifically so people could gain more experience in areas of interest such as research or administration in order to be "leaders in the field". So do you need that elective year to be a good clinician....no...but that extra year wasn`t intended for that purpose.

 

You could make an argument that alot of programs don`t need to be as long as they are.

 

Yeah, the US has 3 year emerg programs but they also have 4 year ones with the 3 year programs being more intensive. It is 3 years of emerg. Unlike our 2 years of office-based family medicine stuff +1 year emerg stuff if you want to compare to our family +1 route. So hard to really compare based on length alone.

 

Similary length of other programs in the US is different than here in Canada. For example, their neurology residency is only 4 years compared to our 5 years, and their family medicine residency is 3 years rather than our 2 years.

 

Personally, I think I would prefer if there was just one route of entry to emergency medicine in Canada that was less than 5 years long ....and then if you had interest in things like critical care or research or admin you could do a fellowhip after rather than starting it in residency. Time-wise it would end up the same if you did the fellowships, but if you just wanted to do just straight emerg you could be done faster and would have a training experience more focused on emerg rather than family. I like emerg, but not so keen on doing a family medicine residency even if it would have me done faster.