Matching to FM/EM

[Dany]

Hi guys,

I will be starting FM this July, and I am 1000% determined to pursue a +1 year in EM.

I know it is pretty competitive, that's why I am asking :

 

- any advices to enhance my chance? I know that I must choose as many electives in EM as possible

 

- anything else? like doing research in EM, get extra certificates (ATLS, Neonatal/obstetrical reanimation etc)

 

- it kinda sucks that my FM site won't be based in the same hospital where the R3 training takes place, which means less chance to directly kiss the asses of the PD... is it really a big deal?

 

 

thanks in advance

[McMasterHopeful]

Hi guys,

I will be starting FM this July, and I am 1000% determined to pursue a +1 year in EM.

I know it is pretty competitive, that's why I am asking :

 

- any advices to enhance my chance? I know that I must choose as many electives in EM as possible

 

- anything else? like doing research in EM, get extra certificates (ATLS, Neonatal/obstetrical reanimation etc)

 

- it kinda sucks that my FM site won't be based in the same hospital where the R3 training takes place, which means less chance to directly suck the asses of the PD... is it really a big deal?

 

 

thanks in advance

 

 

The term kissing is generally used. I dont know anything about sucking. Aside from a poor attempt at humor, i cant add much

[justletmein]

The term kissing is generally used. I dont know anything about sucking. Aside from a poor attempt at humor, i cant add much

 

lolololol ... lost in translation... kiss ass, not suck ass dany

[justletmein]

oh, and for something productive:

 

1) rock your EM rotations

 

2) make it known to people that you want EM. Get great reference letters.

[KennethToronto]

- anything else? like doing research in EM, get extra certificates (ATLS, Neonatal/obstetrical reanimation etc)

 

- it kinda sucks that my FM site won't be based in the same hospital where the R3 training takes place, which means less chance to directly suck the asses of the PD... is it really a big deal?

 

You've answered your own question.

 

Any +1 EM program worth their salt surely would want a candidate who can perform re-animations. In addition to reanimating obstetrical cases, you may consider the RODP certification (reanimation of dead people). I have it from a good source that this will be increasingly in demand.

 

It's no big issue you can't suck the asses of the PD. While your competitors are kissing his ass, the fact you are willing to suck it will put you in good standing.

 

Hope that helps.

[McMasterHopeful]

You've answered your own question.

 

Any +1 EM program worth their salt surely would want a candidate who can perform re-animations. In addition to reanimating obstetrical cases, you may consider the RODP certification (reanimation of dead people). I have it from a good source that this will be increasingly in demand.

 

It's no big issue you can't suck the asses of the PD. While your competitors are kissing his ass, the fact you are willing to suck it will put you in good standing.

 

Hope that helps.

 

just priceless

[Dany]

The term kissing is generally used. I dont know anything about sucking. Aside from a poor attempt at humor, i cant add much

 

corrected

sorry for the misuse

[Dany]

oh, and for something productive:

 

1) rock your EM rotations

 

2) make it known to people that you want EM. Get great reference letters.

 

thanks justletmein

it was hard, like all of sudden EVERYONE in FM wants to do emerg and you gotta compete will ALL of them!!! with current R2's and even previous graduates!!!

[LOCK]

Congrats on matching!

 

Any advice for someone starting a FM residency and wanting to match to FM/EM?

[Dany]

Congrats on matching!

 

Any advice for someone starting a FM residency and wanting to match to FM/EM?

 

To be honest I didn't do so well in the CaRMS and I definitely don't consider myself in the better half even among general FM residents, let alone these EM gunners... I was simply really, really lucky this year, Anyhow...

 

I won't repeat the recommendations from justletmein, which I totally agree.

 

Just to add a few,

1) choose many em electives and do them in different locations (universities). I did 4, in 3 different locations.

2) when you're at a new location (say doing EM elective at University X), shoot an email to the secretary of the local R3 PD, kindly asking for a 5-10min facetime with PD in person, they won't turn you down.

3) You must woo your primary family medicine preceptor (whose LoR is required for most R3 programs) and pretty much everyone else, like each and every attending you work with in your CTU rotation, and every single RN at LDR. Watch out the RNs, rubbing them the wrong way just once could screw up your whole rotation eval (yeah *they* talk to each other about you), adding a red flag for your CaRMS application - I speak from my own experience...

4) Start your application early. I started my Essay in August, and still felt short of time

 

hope it helps

[Nobodycirclesthewagons]

Speaking of sucking ass

 

[steve1234]

how tough is it to match to FM/EM after applying broadly?

 

FM/EM is what I really see myself doing after medical school - the competitiveness has me a bit worried - I would LOVE that mix though.

[steve1234]

Also, can someone comment on the available positions for FM docs to work in the ER without the + 1 (I have heard that FM docs in oakville/georgetown without a +1 still work in the ER) - ) have heard that you can do training after the FM residency to get more ER skills to make yourself comfortable in that environment.

 

Basically i'm trying to think of what I would do if I can't match to the FM/EM program - what alternatives would you all suggest?

[rogerroger]

Also, can someone comment on the available positions for FM docs to work in the ER without the + 1 (I have heard that FM docs in oakville/georgetown without a +1 still work in the ER) - ) have heard that you can do training after the FM residency to get more ER skills to make yourself comfortable in that environment.

 

Basically i'm trying to think of what I would do if I can't match to the FM/EM program - what alternatives would you all suggest?

 

 

Yeah there are other routes that can be taken, but I'm not familiar enough to comment in depth. This said, if you don't do additional EM dedicated training I imagine your career mobility as a new doc will be severely limited right off the hop and maybe more so as the years go on. Royal college spots are increasing as a trend and then you have the CCFP guys on top of that. The job situation in EM is getting tighter. It still is good overall. But the trend is something to keep in mind. The era to work in the ER without dedicated training is probably coming to an end. Unless you are considering the most rural and remote places...

 

Job mobility: FRCP > CCFP > other

Ease of getting in: FRCP > CCFP

 

I imagine some of you may strongly disagree with what I'm about to say. But humour me for a moment. Personally, I would be very concerned about working with limited ED staff backup in a resource poor rural Emerg at this point in my career - 2 years of dedicated Emerg training under my belt. I know enough to know what I don't know. I can't imagine NOT having intensive acute medicine training and working in the ED. When did you last intubate someone? Maybe you were lucky and did some anesthesia rotations... This is just the tip of the iceberg.

 

If you can only see yourself doing EM I would work your way down the above list in the obvious order.

 

However, FM is a grab bag of opportunities. If you are open to not doing EM the other options are numerous.

[estairella]

Also, can someone comment on the available positions for FM docs to work in the ER without the + 1 (I have heard that FM docs in oakville/georgetown without a +1 still work in the ER) - ) have heard that you can do training after the FM residency to get more ER skills to make yourself comfortable in that environment.

 

Basically i'm trying to think of what I would do if I can't match to the FM/EM program - what alternatives would you all suggest?

 

It's fairly difficult to get a full-time position doing only ER unless you are quite rural (even then you are expected to do some family/urgent care because that's where the need lies) without a +1 but relatively easy to do ER shifts in many community hospitals as part of your general family practice. You need 400 hours / year x 4 years to challenge the exam which, if you think about it, is 50 shifts a year (assuming 8 hour shifts) so less than 1 shift a week. Furthermore, many rural/small town emergs operate on a 10-hour shift schedule making the requirements even easier to meet. It is of course 4 more years and possibly doing something you may hate.

 

I imagine some of you may strongly disagree with what I'm about to say. But humour me for a moment. Personally, I would be very concerned about working with limited ED staff backup in a resource poor rural Emerg at this point in my career - 2 years of dedicated Emerg training under my belt. I know enough to know what I don't know. I can't imagine NOT having intensive acute medicine training and working in the ED. When did you last intubate someone? Maybe you were lucky and did some anesthesia rotations... This is just the tip of the iceberg.

 

This is such an FRCPC thing to say I had to have a laugh Rogerroger is completely right, of course, if the thought of having to do a difficult intubation, start a levophed drip, manage an asthma epilepticus, start a central line, cardiovert an unstable v-tach, run a bad trauma, put in a chest tube, manage a septic shock/severe met. acidosis etc. etc. all by yourself with is terrifying, the 2+1 is not for you. The funny/ironic thing of course, is that after 5 years of dedicated training with loads of critical care, once you finally feel comfortable working in that small town ED, most likely you'd rather work in a large tertiary hospital ED where you no longer have to use 90% of the skills you learned because it's much easier just to consult one of the twenty services on-call 24/7 (not that there's anything wrong with that).

 

All the things I've listed, btw are things I've done (most more than once). Am I comfortable with really sick patients? Nope - I still **** my pants internally. Am I more comfortable than the typical PGY2 emerg resident who still casts a differential 6+ items long and still takes +20 minutes to see a patient with any kind of complexity? Heck yes.

[Real Beef]

The funny/ironic thing of course, is that after 5 years of dedicated training with loads of critical care, once you finally feel comfortable working in that small town ED, most likely you'd rather work in a large tertiary hospital ED where you no longer have to use 90% of the skills you learned because it's much easier just to consult one of the twenty services on-call 24/7 (not that there's anything wrong with that).

 

 

I keep hearing anecdotally that FRCP emerg physicians dont use all their skills. Is it a matter of that they could manage certain patient populations but due to the busy ED they would rather consult and keep the flow moving? or is it that it is frowned upon by consulting services that the EM physicians are managing patients that could be better served on a specialty floor with closer monitoring/more specialized monitoring/nursing services?

 

Sorry to derail the thread. Just asking for clarification of a comment made that I keep hearing.

 

Beef

[A-Stark]

I spend a lot of time in emerg, albeit as a consultant for variably-worked-up patients. Most of the time it's the usual mix of abdominal pain, PV bleeding, and vague nonspecific stuff (when I've been on emerg), and it's only a minority of patients sick enough to be consulted to medicine or cardiology that need pressors or lines. I've never seen emerg really managing a truly difficult airway, and that's not even really appropriate where there is anesthesia in-house.

 

We certainly will "frown upon" EM physicians who consult without a good question or without adequate workup, but as residents we don't have much of any ability to refuse to see a patient. It's not unheard of to be seeing direct consults that arrive unstable in emerg too - and the ERPs don't get involved with them at all.

 

The simple fact is that no one can be an expert at everything, and the generalist nature of emergency medicine means a focus on acute stabilization and efficient determination of disposition. The further on you go, the less it becomes about procedures and the more it becomes about decision-making. Learning to place a central line isn't altogether difficult. Determining when a patient needs a Swan, and balancing this against complications and what you'll do with all that hemodynamic information, requires experience.

 

When I'm on cardio call, I cover CCU, every floor patient, consults from emerg, other services, and recovery, and carry the code pager. A few weeks ago, the CCU was half-filled with vented patients, several had Swans, one was recently parted from an assist device, and another had a pump. The CCFP-EM residents do the same call, but it works out to an eighth (or less) of the cardio experience of IM residents by the end of R3. FRCPC residents will do more but not *that* much more. And if I have any point to this, it's simply that there will always be someone with more experience and more facilities - and the more isolated your centre, the more important initial stabilization and prompt referral becomes.

[Dany]

Also, can someone comment on the available positions for FM docs to work in the ER without the + 1 (I have heard that FM docs in oakville/georgetown without a +1 still work in the ER) - ) have heard that you can do training after the FM residency to get more ER skills to make yourself comfortable in that environment.

 

Basically i'm trying to think of what I would do if I can't match to the FM/EM program - what alternatives would you all suggest?

 

Hi Steve,

before I got this R3 spot I did extensive FM, EM+EM, EM job searches across Canada, so here are my 2 cents:

 

1) available positions for FM docs to work in the ER without the + 1

First, I am speaking of all the new graduates, which doesn't include all those old GPs who could grandfather the full-time position in ED through years of experience.

All the reasonably bigger centers (with medschools - like Edmonton, St-John's; OR satelite campuses - like Victoria, Kelowna, Sudbury) all require at least CCFP-EM - if not FRCP. For example, a mere CCFP-EM is kinda hard to land an EM job in Calgary nowadays.

Here are the examples of the smaller regional centres (w/o medschool teaching facilities) that also mandate CCFP-EM: Campbell River, Red Deer, Windsor,

The smallest hospitals (like Sechelt, Port Hardy, Fort Frances, Ajax) don't require an R3 training, BUT they don't offer full-time EM jobs (so the shifts are shared between local GPs)

 

The small communities that do offer full-time EM jobs (w/o requiring R3) are, as far as I know: Chatham, Muskoka

The ONLY big city that also hires "pure" FP graduates is Montreal. I personally had an attending who was just freshly graduated from FM, and got a FT job in a community hospital in MTL

 

2) Basically i'm trying to think of what I would do if I can't match to the FM/EM program - what alternatives would you all suggest?

very good question.

It depends on if you're really *hardcore* about EM. Personally I would either find a FT ED job in a rural centre, or I would do a mix of GP/ER while making sure that I accumulate enough ED hours so that I could challenge the CCFP-EM exam down the road (400 on-site ED hours/year, for 4 consecutive years)

 

I can't comment on doing a +1 year of something else (GPA, pall, OB...) then reapplying the R3-EM, but I personally know someone who failed this route after finishing his/her GPA year (he/she was a strong candidate...)

[thebouque]

test 10char

[steve1234]

Hi Steve,

before I got this R3 spot I did extensive FM, EM+EM, EM job searches across Canada, so here are my 2 cents:

 

1) available positions for FM docs to work in the ER without the + 1

First, I am speaking of all the new graduates, which doesn't include all those old GPs who could grandfather the full-time position in ED through years of experience.

All the reasonably bigger centers (with medschools - like Edmonton, St-John's; OR satelite campuses - like Victoria, Kelowna, Sudbury) all require at least CCFP-EM - if not FRCP. For example, a mere CCFP-EM is kinda hard to land an EM job in Calgary nowadays.

Here are the examples of the smaller regional centres (w/o medschool teaching facilities) that also mandate CCFP-EM: Campbell River, Red Deer, Windsor,

The smallest hospitals (like Sechelt, Port Hardy, Fort Frances, Ajax) don't require an R3 training, BUT they don't offer full-time EM jobs (so the shifts are shared between local GPs)

 

The small communities that do offer full-time EM jobs (w/o requiring R3) are, as far as I know: Chatham, Muskoka

The ONLY big city that also hires "pure" FP graduates is Montreal. I personally had an attending who was just freshly graduated from FM, and got a FT job in a community hospital in MTL

 

2) Basically i'm trying to think of what I would do if I can't match to the FM/EM program - what alternatives would you all suggest?

very good question.

It depends on if you're really *hardcore* about EM. Personally I would either find a FT ED job in a rural centre, or I would do a mix of GP/ER while making sure that I accumulate enough ED hours so that I could challenge the CCFP-EM exam down the road (400 on-site ED hours/year, for 4 consecutive years)

 

I can't comment on doing a +1 year of something else (GPA, pall, OB...) then reapplying the R3-EM, but I personally know someone who failed this route after finishing his/her GPA year (he/she was a strong candidate...)

 

 

Hey Dan,

 

Thank you for this detailed response!

I like the idea of doing EM shifts as a GP (for backup) and I was wondering how easy is it to get those? Are they competitive as well? For example, in the suburbs of Toronto (ie Oakville/Mississauga)?

 

To be honest, I love the idea of a CCFP +1 and want to practice both at the same time - will it be reasonable for me to pick up EM shifts then? I'm cool with not having a full time EM position. And then I would aim to challenge that exam.

[Dany]

Hey Dan,

 

Thank you for this detailed response!

I like the idea of doing EM shifts as a GP (for backup) and I was wondering how easy is it to get those? Are they competitive as well? For example, in the suburbs of Toronto (ie Oakville/Mississauga)?

 

To be honest, I love the idea of a CCFP +1 and want to practice both at the same time - will it be reasonable for me to pick up EM shifts then? I'm cool with not having a full time EM position. And then I would aim to challenge that exam.

 

Doing EM shifts as a GP is NOT competitive at all in smaller centres, Oakville maybe, Mississauga I'm not so sure.

As I mentioned, the crucial part to challenge the exam is accumulate *enough* hours (400) per year which is not always guaranteed, but definitely doable if you don't mind 1) waiting for four years 2) geographical locations - it doesn't have to be Iqualuit or Churchill or Fort Frances, of course.

 

Here is the link to Health Force Ontario physician's job search. You can search by location or practice type (FP, FP/ER, ER-fulltime, FP/GPA, FP/OB etc), and you can also combine your criteria.

 

https://hfojobs.healthforceontario.ca/en/list/?p=1&t=7&pt=2

 

Cheers

[BoyInTheBubble]

This is true in general, but it's not that black and white. In general, the academic centres and urban areas are harder to get a job. This goes for pretty much everything!

 

There are more job openings that don't get listed.

 

If you really want a job at one site, go talk to them. "I'm joe blow and really want to live and work in XYZ and I'm committed to working in the ER". This will get you far.

 

Even the more desirable and harder to get into places have very high turnover and are often looking for people to work there (full time or just covering shifts).

 

I know two second year residents who have their full time ER jobs lined up. Both are doing the PGY3 ER starting in July, but were asked if they wanted to start this summer (aka skip the extra year of training).

 

Also, even if you don't get in to the ER year, you should be interested in learning the material and saying yes to every ER-related experience that you can. The PGY3 organizes the training for you, but you can learn it all without the program - it's just more challenging. U of T runs the SEME program (like a 3 month ER primer or something.) Lots of options out there!

[DrWhom]

Whats the competition situation out west? Through UBC etc.

 

All the FP residence info sheets on Carms say "Further Training:

 

Third year training positions are available in the area of Emergency Medicine, Care of The Elderly, Anesthesia, Research, Palliative Medicine, Clinical Scholarship program and a wide range of other Enhanced Skills."

 

How does it work, you finish your PHY1 and 2 then apply to stay on an extra year in the ER? Then what if they say no?

[Dany]

Whats the competition situation out west? Through UBC etc.

 

All the FP residence info sheets on Carms say "Further Training:

 

Third year training positions are available in the area of Emergency Medicine, Care of The Elderly, Anesthesia, Research, Palliative Medicine, Clinical Scholarship program and a wide range of other Enhanced Skills."

 

to answer your question

 

1. the competition out west is like in East, universities tend to somewhat favour their own residents (ie. if you're FM resident at UBC you have a higher chance of matching to UBC R3 emerg

 

How does it work, you finish your PHY1 and 2 then apply to stay on an extra year in the ER? Then what if they say no?

 

2. it works like this: you apply R3 at the beginning of R2 of family med. Thru CaRMS for EM, and for other programs (GPA, obs, geriatrics etc) you apply to each university individually, like when you applied to med school. They all have different application deadlines so be informed.

 

If you finish your PGY2 then apply an extra year of whatever enhanced skill program and they say no, then you HAVE NO CHOICE BUT to suffer one year sooner from a $250k/year income instead of 50k

[arryn]

Can you reapply for a +1 later on if you fail to get in right after pgy-2? Is that frowned upon?