Can you open a walk in clinic/work in a family practice as an EM doc?

[shannn]

I've always wondered this...

 

Because, I'm starting to really get interested in EM, but I don't know if I can do it for the rest of my life...and it doesn't sound like the 2+1 FM+EM is going to be around much longer...

[Karma]

No yo can't. To do this you have to be a family doc.

 

I heard that the EM specialty is not going to «take off» on the contrary, because it costs more to thegovernment to hire an EM specialist than an FM+1 an they do almost exactly the same thing. The EM is a VERY recent specialty.

 

As an FM+1, you can work in the hospital and in a clinic.

 

 

 

 

Heres's what wikipedia says:

 

In Canada, there are two routes to certification in emergency medicine. The vast majority of full-time practicing ER physicians in Canada are certified via one of these routes. Most busy urban, sub-urban and larger rural hospitals are staffed primarily by full time, certified career emergency physicians. Smaller rural and community hospitals may still be staffed by family physicians who work in the emergency department on a part-time rotating basis. Basic experience in emergency medicine is a core component of family medicine training in Canada. The general trend in Canadian emergency departments over the last decade has been the gradual replacement of part-time, non-certified physicians (mostly family physicians) by full-time certified emergency physicians. This trend was first noted in larger academic centers but has gradually evolved to include most busy emergency departments.

 

The two routes to ER certification can be summarized as follows:

 

Route 1: A five year residency leading to the designation of FRCP(EM) through the Royal College of Physicians and Surgeons of Canada. Route 2: A 3 year residency leading to the designation of CCFP(EM) through the College of Family Physicians of Canada.

 

CCFP(EM) ER physicians outnumber FRCP(EM) physicians by about 3 to 1, and tend to work primarily as clinicians with a smaller focus on academic activities such as teaching and research. FRCP(EM) ER physicians tend to congregate in academic centers and tend to have more academically oriented careers, which emphasize administration, research and teaching. Furthermore the length of the FRCP(EM) residency allows more time for formal training in these areas.

 

As a consequence of the above, most Canadian medical students who wish to pursue an academic emergency medicine career, and/or work primarily in a major academic center, choose the FRCP route of certification. Conversely, those who wish to function primarily as clinical ER physicians choose the CCFP route of certification.

 

Although many in the Emergency Medicine community in Canada feel that a unified training process would be beneficial to the current 2 stream schism, this has yet to happen for a variety of complex reasons.

[rmorelan]

I've always wondered this...

 

Because, I'm starting to really get interested in EM, but I don't know if I can do it for the rest of my life...and it doesn't sound like the 2+1 FM+EM is going to be around much longer...

 

Hey that is interesting - what makes you think the 2+1 is going away?

[shannn]

Hey that is interesting - what makes you think the 2+1 is going away?

 

At one of our Emergency Medicine interest group talks, they were discussing how the 2+1 option for EM is likely to get axed.

 

I'm not crystal clear about the details because I didn't attend, but does anyone have any light to shed on it? A lot of Ottawa people have been telling me the same about the 2+1 eventually coming to an end for EM

[Renin]

At one of our Emergency Medicine interest group talks, they were discussing how the 2+1 option for EM is likely to get axed.

 

I'm not crystal clear about the details because I didn't attend, but does anyone have any light to shed on it? A lot of Ottawa people have been telling me the same about the 2+1 eventually coming to an end for EM

 

I have heard that 5 year is going to get replaced WITH 2+1... perhaps with a merger creating a 3-4 year program.

 

Who knows

[shannn]

I have heard that 5 year is going to get replaced WITH 2+1... perhaps with a merger creating a 3-4 year program.

 

Who knows

 

Really?

 

Hmm, I'm really curious now, I'm gonna go ask around...

 

So many 2nd years were saying how the 2+1 was being dropped in favour of 5 years, and it had a lot of people who wanted to do community/rural EM upset because the 3 year program makes more sense for them in a rural/community setting.

[Renin]

Really?

 

Hmm, I'm really curious now, I'm gonna go ask around...

 

So many 2nd years were saying how the 2+1 was being dropped in favour of 5 years, and it had a lot of people who wanted to do community/rural EM upset because the 3 year program makes more sense for them in a rural/community setting.

 

That is curious; I have not heard this at all.

[rmorelan]

Really?

 

Hmm, I'm really curious now, I'm gonna go ask around...

 

So many 2nd years were saying how the 2+1 was being dropped in favour of 5 years, and it had a lot of people who wanted to do community/rural EM upset because the 3 year program makes more sense for them in a rural/community setting.

 

exactly why I doubt it is going away - it is not in the best interests of our underservieced populations, the 2+1 has a track record of serving patients well and there have ben no serious concerns otherwise about it that I have heard.

 

Doesn't mention that it couldn't happen but I would be very surprised

[shannn]

exactly why I doubt it is going away - it is not in the best interests of our underservieced populations, the 2+1 has a track record of serving patients well and there have ben no serious concerns otherwise about it that I have heard.

 

Doesn't mention that it couldn't happen but I would be very surprised

 

That's what I thought too, it seems very counterintuitive...

 

But anyway, does anyone know if I can open a walk in or let's say, do a walk in clinic parallel to a FM doctor in a clinic as an EM doc?

[Renin]

That's what I thought too, it seems very counterintuitive...

 

But anyway, does anyone know if I can open a walk in or let's say, do a walk in clinic parallel to a FM doctor in a clinic as an EM doc?

 

YES as a 2+1 yr ER doc

NO as a 5 yr ER doc

 

You can work in tertiary centers which sort of have a spill over system in which lower ranked cases on the triage system (often 3, 4 and 5's) get shifted over to a "walk-in-like" alternative track. It's called Fast Track at U of M's children's ER, dunno what it's called for adults (E-track?).

 

But you can't open a walk in by yourself. You're tied to the ER if you're a 5-yr ER doc.

[kaymcee]

I've always wondered this...

 

Because, I'm starting to really get interested in EM, but I don't know if I can do it for the rest of my life...and it doesn't sound like the 2+1 FM+EM is going to be around much longer...

I was interested in FRCP emergency medicine, but I went to write a CaRMS letter and couldn't find a reason that I wanted to spend five years training to practice the same medicine I could do with three years', and with less flexibility in terms of what you mention. And when I'm forty-five, I want to be sleeping at home with my wife on a Wednesday at 3 AM rather than cracking open a chest...

 

I don't see the CCFP(EM) program going away any time soon. It's a natural extension of family medicine residency, and allows for better-trained family physicians to work in EDs in cities/towns/hamlets of all sizes. More than in other CCFP enhanced skills programs, there is greater mutual respect in emergency medicine between the royal college and college of family physicians practitioners, and each route to becoming an emergency physician appeals to different people.

 

You've got quite a lot of time to figure out what you want; medical school started for you just a few months ago. They may make a surgeon out of you yet!

[hastin11]

So...what IS the benefit of doing the 5-year ER option? Money? Im actually very confused, it seems like 2 more years of training while being able to do less--there must be some upside, or no one would do this.

[Karma]

You're paid a specialists salary, you can do research and have more important teaching responsabilities than a 1+2 I think.

 

As a 1+2, you're paid a generalist's salary.

[rmorelan]

So...what IS the benefit of doing the 5-year ER option? Money? Im actually very confused, it seems like 2 more years of training while being able to do less--there must be some upside, or no one would do this.

 

Pay is the same but you do have more specialized training so are initially at least much better at handling certain situations. Some major hospitals prefer 5 year ER docs, and your oportunities are higher for research.

[kaymcee]

You're paid a specialists salary, you can do research and have more important teaching responsabilities than a 1+2 I think.

 

As a 1+2, you're paid a generalist's salary.

I do not want to personally insult you, but there are many things wrong with your post, evidence of someone who is not in medicine commenting on something they have no knowledge of:

 

In Canada, a physician bills—that is, charges one of the provincial health care plans—based on what he does, which has nothing to do with his certification. A specialist gets paid more for a consultation, yes, but a CCFP, CCFP(EM), and FRCPC emergency physician can bill the same codes.

 

There's no difference in teaching.

[Karma]

Hehe, just because I don't put in my signature that I'm in med school does'nt mean i'm not a med student:) Which I actually am.

 

I'm francophone so I might sometimes use words not in their exact sens, but I said in my post exactly the same thing you did. EM are paid more because they can charge more for doing almost the same thing as the 2+1, because they have more years of training.

 

And there actually is a difference in teaching. In my med school FM often teach in small groups, while the EM are actually responsable for organising the whole class.

[Renin]

2+1 ER docs = traditionally more rural; more clinical small group skills teaching, some are involved in traditional teaching that is lecture based, but most of them are not; limited involvement in academic research and administration policy making

 

5 ER docs = traditionally tertiary centers; more large-group teaching, ie: lectures; more involvement in research and administration

 

No pay difference.

[shannn]

I've always found it a little ironic that if you do a 5 year residency, you are more likely to work at an urban centre ED where you don't really do as much as someone doing ED in a rural community (who often goes the 2+1 route).

 

Because in a rural setting, you are likely to have to handle more complex situations yourself instead of paging someone else to deal with it (unless you realllllly cannot do it).

 

But research in emergency med seems interesting, but I would also be interested in working as an FM doc once or twice a week as well...man, that's too bad.

 

As an ER doc, can I re-enter carms later to pursue FM?

 

Honestly, sometimes I feel that a 2+3 option for EM would make so much sense, similar to how IM works before specialization.

 

...ah well, maybe I'll just become an orthopod like I intended to do when I first got in

[rmorelan]

I've always found it a little ironic that if you do a 5 year residency, you are more likely to work at an urban centre ED where you don't really do as much as someone doing ED in a rural community (who often goes the 2+1 route).

 

Because in a rural setting, you are likely to have to handle more complex situations yourself instead of paging someone else to deal with it (unless you realllllly cannot do it).

 

But research in emergency med seems interesting, but I would also be interested in working as an FM doc once or twice a week as well...man, that's too bad.

 

As an ER doc, can I re-enter carms later to pursue FM?

 

Honestly, sometimes I feel that a 2+3 option for EM would make so much sense, similar to how IM works before specialization.

 

...ah well, maybe I'll just become an orthopod like I intended to do when I first got in

 

you can reenter the race to get a fm spot later on. that would sure be annoying as you would be a practising ER doc but you start right back at square one in terms of the new one.

[Ollie]

I'm francophone so I might sometimes use words not in their exact sens, but I said in my post exactly the same thing you did. EM are paid more because they can charge more for doing almost the same thing as the 2+1, because they have more years of training.

Maybe this is the case in some provinces but in BC CCFP-EMs and FRCPs get bill the same.

[leviathan]

I'm francophone so I might sometimes use words not in their exact sens, but I said in my post exactly the same thing you did. EM are paid more because they can charge more for doing almost the same thing as the 2+1, because they have more years of training.

Maybe things are done differently in Quebec, but the pay / billing codes are the same if you are a 2+1 or a 5 year everywhere else in Canada.

[rmorelan]

Maybe things are done differently in Quebec, but the pay / billing codes are the same if you are a 2+1 or a 5 year everywhere else in Canada.

 

exactly - it is actually a point of complaint in Ontario from the 5 years is that they get paid exactly the same as a 2+1. The government sees no difference in billing terms between them and it was my understanding it was similar in many other parts of the country. As a result increased finanical return is not one of the commonly given reasons for chosing the 5 year over the 2+1.

[Renin]

you can reenter the race to get a fm spot later on. that would sure be annoying as you would be a practising ER doc but you start right back at square one in terms of the new one.

 

lol, I wouldn't ever do that ... another 2 years of medical school because ... ? I'd just go down to working half time or w/e.

[Karma]

I heard several times that EM are paid more in Quebec than the 2+1. That makes sens, because usually specialists are paid more than the generalists. I had no idea that it's different in other provinces.

 

I found an article on the internet that confirms it. It's in french unfortunately, I couldn't find anything in english.

 

 

http://www.radio-canada.ca/regions/Quebec/nouvelles/200210/08/005-urgences.shtml

[Maxime]

In Quebec, billing codes are different, and so is the pay. I once heard it was 15-20% difference, maybe less.

 

For the 4 year combination program instead of 2+1 and 5, it's been on the table for years, and nothing has changed since. We'll see if it ever comes into effect...

 

I highly doubt that the 2+1 will go away, considering the fact that the vast majority of ER docs are only FM trained (no extra ER training), and that there are only 45 spots in all of Canada for the FRCPC program... Maybe they want you FRCPC trained in BC (why?), but you'll have ABSOLUTELY no problem getting a job in some of Montreals most busy ERs being only FM trained (HMR (the most occupied ER in all of Quebec), HSL and other smaller ones).