CCFP FM/ER Fellowship?

[Noplanb]

I know that CCFP FM/ER has been discussed extensively, but I need to know one more thing.

Can I do some sort of fellowship in this program?

I would like to focus on the ER side of this program, and only as a backup to the RCPS ER Medicine residency.

Just Curious.

Thanks.

[ploughboy]

I know that CCFP FM/ER has been discussed extensively, but I need to know one more thing.

Can I do some sort of fellowship in this program?

I would like to focus on the ER side of this program, and only as a backup to the RCPS ER Medicine residency.

Just Curious.

Thanks.

 

I'm not sure what you're asking. You do two years of family medicine, then an extra year of emergency training. Assuming that you pass your exams, you're free to work full-time as an emergency physician after that. Nobody will force you to work as an 8-4-Monday-to-Friday-and-golf-on-Wednesday-afternoons family doctor. Given the shortage of emergency physicians in the province, a lot of CCFP(EM)'s choose to work solely as emergency docs.

[Noplanb]

Sorry.

I'll just clarify my first post a bit.

There is a residency program (CCFP) where you do 3 years (2 in FM and one in ER).

If I do this residency program can I follow it up with some sort of fellowship if I believe that the one year of ER training is inadaquate?

[Satsuma]

What kind of fellowship are you thinking of? Generally, I think the answer to your question is no, in terms of fellowships like critical care or pediatric emerg etc.

 

But I have worked with some 2+1 emerg docs who did a year of trauma in the US etc to gain extra training. This extra year isn`t formally recognised by the college.

 

Of course you could do any other additional year open to family docs...anesthesia, sports med etc.

 

But you should feel prepared after the extra EM year, I would think. This is generally what people have been saying anyway.

 

Even alot of the 5-years seem to be saying they don`t think it takes 5 years to learn emerg.

[Fred]

I just want to clarify one point in your posts Noplanb:

 

3 years CCFP/EM residencies do not exist per se:

 

When you match to family med, you are garanteed 2 years of training. You need to go through another match to do the 3rd year.

There are other 3rd year programs available and nothing stops you from doing one more.

You could always get more training into some area ( I know a CCFP/EM who is doing toxicology right now) but this training is not really a fellowship as say, critical care after the 5 years emerg residency.

[Noplanb]

Okay!

This is a little bit clearer now.

I wasn't aware that there was a second match for the CCFP ER program.

I was just a little bit worried that the training was inadaquate since the RCPS program was 5 yrs.

 

Thanks for all your insight!

[ploughboy]

But you should feel prepared after the extra EM year, I would think. This is generally what people have been saying anyway.

 

Even alot of the 5-years seem to be saying they don`t think it takes 5 years to learn emerg.

 

Tangentially...I'm bouncing around the idea of doing a "2+2", with extra training in both anaesthesia and emergency. A huge chunk of what comes into emergency rooms could be just as easily handled in a family medicine clinic, but the people who show up in the ER really sick are *really* sick. That means they need lines, tubes and fun drugs, which is bread-and-butter for anesthesiologists. If I do wind up practicing emergency medicine in the periphery I think I'd benefit from another year of practicing sticking foreign objects into patients. But that's just me.

 

(Of course, depending on the whims of CaRMS I might wind up doing FRCPC something-or-other and then a critical care fellowship after that...six years of lines and tubes and poking things into people...)

 

Anybody else having similar thoughts?

 

pb

 

PS for original poster - http://carms.ca/eng/r3_about_intro_e.shtml

[The_B]

Tangentially...I'm bouncing around the idea of doing a "2+2", with extra training in both anaesthesia and emergency. A huge chunk of what comes into emergency rooms could be just as easily handled in a family medicine clinic, but the people who show up in the ER really sick are *really* sick. That means they need lines, tubes and fun drugs, which is bread-and-butter for anesthesiologists. If I do wind up practicing emergency medicine in the periphery I think I'd benefit from another year of practicing sticking foreign objects into patients. But that's just me.

 

(Of course, depending on the whims of CaRMS I might wind up doing FRCPC something-or-other and then a critical care fellowship after that...six years of lines and tubes and poking things into people...)

 

Anybody else having similar thoughts?

 

pb

 

PS for original poster - http://carms.ca/eng/r3_about_intro_e.shtml

 

I was thinking the same thing, so I am interested to hear responses. My concern was always being able to get an additional year of funding after the first +1.

[ploughboy]

I was thinking the same thing, so I am interested to hear responses. My concern was always being able to get an additional year of funding after the first +1.

 

The hospital closest to my hometown is short about half-a-dozen emergency docs, and some of those who remain are teetering on the edge of burn-out. I don't anticipate any difficulty in getting funded in exchange for a return-of-service-agreement. Avoiding burnout myself may be a bigger problem. I think there are lots of communities out there offering ROSAs, so it's just a matter of choosing.

 

pb

[JewelLeigh]

Why not just do a 2+1 in anesthesia alone and skip the other year in emerg? As you point out, much of emerg med is walk-in clinic stuff (which you'll learn in the 2 years of family med) and the remainder are the sickies who need critical care. Anesthesia training will prepare you well for these critical care type patients imo.

 

Additionally...how peripheral are you thinking when you mention where you want to work? Smaller hospitals, such as where I work, require no additional training beyond family med residency to work in their emerg. Ours is staffed entirely by family docs, only one of whom has a +1 in emerg and three of whom have +1's in anes...that leaves probably at least another 10 docs who have no +1 year and who are fabulous ER docs. It makes a plan to do 4 years of post-grad training (2 family, +1 emerg, +1 anes) sound a little excessive if this is the kind of place you're going for (24 hour emerg, no ambulances with trauma, but get most other things).

 

If it's a comfort level thing...instead of asking for a ROSA to pay for another year of residency, consider asking for a mentoring program. Again, where I work, there is funding for new docs to do emerg shifts that are always booked together with more experienced ER docs. The experience docs act as mentors to the new ER docs for the first while. The new docs get paid the same hourly rate as the experienced ER docs, but know they'll never be working the emerg dept alone for the first six (or so) months. You basically see patients as you would if you were alone, but you know someone else is there to answer questions, help out, etc., if you are unsure.

[ploughboy]

Why not just do a 2+1 in anesthesia alone and skip the other year in emerg? As you point out, much of emerg med is walk-in clinic stuff (which you'll learn in the 2 years of family med) and the remainder are the sickies who need critical care. Anesthesia training will prepare you well for these critical care type patients imo.

 

Additionally...how peripheral are you thinking when you mention where you want to work? Smaller hospitals, such as where I work, require no additional training beyond family med residency to work in their emerg. Ours is staffed entirely by family docs, only one of whom has a +1 in emerg and three of whom have +1's in anes...that leaves probably at least another 10 docs who have no +1 year and who are fabulous ER docs. It makes a plan to do 4 years of post-grad training (2 family, +1 emerg, +1 anes) sound a little excessive if this is the kind of place you're going for (24 hour emerg, no ambulances with trauma, but get most other things).

 

If it's a comfort level thing...instead of asking for a ROSA to pay for another year of residency, consider asking for a mentoring program. Again, where I work, there is funding for new docs to do emerg shifts that are always booked together with more experienced ER docs. The experience docs act as mentors to the new ER docs for the first while. The new docs get paid the same hourly rate as the experienced ER docs, but know they'll never be working the emerg dept alone for the first six (or so) months. You basically see patients as you would if you were alone, but you know someone else is there to answer questions, help out, etc., if you are unsure.

 

Hey JL,

 

It's totally a comfort level thing for me, and as an M4 it's hard for me to predict how confident I'm going to feel in my skills in 2 or 3 years time. Right now I have days where I feel like I could manage a ward or ER all by myself, and other days that I'm amazed that my patients don't all die due to my stupidity.

 

I wouldn't need a formal CCFP(EM) to work where I'm thinking of working, and your point about a mentoring program vs a ROSA is very well taken. I'm pretty sure the hospital that I have in mind has done that in the past with some of their ER docs. It's a small city, and the staff is a mix of FRCPC, CCFP(EM) and family docs. However, they deal with all the bad stuff that comes in from a large geographic area with a significant seasonal population. Somebody once described it to me as a "level two and a half" hospital. There's good imaging, surgical and critical care support, so a lot of the really sick and injured can be dealt with in-house. The super-crazy cases (and all the neuro) get flown out, however.

 

Not sure how my post-grad education is gonna unfold, but it's fun to think about. How do you like Mac's rural programme?

 

pb

[JewelLeigh]

I love it! You definitely have to go above and beyond to advocate for your own learning when in such a small program with very unique challenges...but for someone who is up for that/committed to it - the opportunities are amazing! For example - today I worked emerg and was on call for OB...the ED was relatively slow but steady, so my preceptor basically let me run the department but was there to back me up if I needed it. During the day I also ran over to OB where I delivered a baby and did the vaginal repair. At the end of my shift, I assisted on an urgent C-section and got to close. Altogether a great day

 

For me, it's a bonus because I will be staying in this particular community to practice in the long run - so I am getting to know the administrative side of things, the staff, the other doctors, etc.