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R4 match from Emergency Medicine in Critical Care


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I was under the impression that all CCU fellowships matched from either internal or anesthesia... However, looking at the match results it looks like you can come from a variety of specialities in the R4 match (see below). Can anyone explain how the R4 match works from Emergency Medicine? When would you write your boards for EM etc? In my opinion this makes the 5 year EM program far more attractive... Anybody with any information about sub-specializing in Critical Care from Emerg can you please comment..


Number of Applicants Matched to Adult Critical Care Medicine by Discipline of Residency 2010 R-4 Medicine Subspecialty Match

Discipline of Residency Matched

Anesthesiology 7

Cardiac Surgery 1

Emergency Medicine 2

Internal Medicine 18

Neurology 1

Otolaryngology - Head & Neck Surgery 1

Other 1

Total 31

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You need to have finished at least 3 years of your base specialty, and be on track to finish all the Royal College required elements of training prior to entry in the Critical Care Medicine program. That's the Royal College's requirement, but your base specialty training program will also have to let you out of your training early, or allow you to do months concurrently. This sometimes takes discussion between the program directors.


For IM it works because only the first 3 years are enough to fulfill the IM requirements, and you have to match to a 4th year of training anyway, so there is no expectation that you will remain in the same program. I believe most other base specialties want their residents to finish all the years of their commitment before moving to a different program, even if their required time is done. You would have to work it out with the CCM and EM program directors on a case by case basis, I believe.

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Thanks cheech That makes sense and also explains why so few em people do this option. I was just exploring some if the em and critical care program websites and it looks like em programs are flexible but many critical care programs are not (will not allow for taking both programs at the same time). IM definitely seems like the most natural route to critical care. I've heard the sports med certificate/fellowship does integrate well with most EM programs. I know it's totally different but it would be another good way to diversify your practice albeit something you would have to love because the reimbursement isn't very good.

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  • 2 weeks later...
I've met a few residents who went into critical care from FRCPC EM programs. Maybe pb can shed more light.


A number of folks do it, though in my unscientific estimation maybe fewer are doing it since the R4 match began being administered by CaRMS. In a perfect world you would do R1-R3 in EM, R4 in CCM, R5 in EM and R6 in CCM. However, my understanding from people who have gone through the R4 match is that a lot of CCM programs really don't want you to split your two-year fellowship over three years and that might be one of several limiting factors. Me? I didn't apply.


As for other EM subspecialties, let's make that another thread for another time.

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