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FRCPC or CCFP-EM - the eternal EM discussion


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It's funny - after doing clerkship rotations in family medicine, I have far more respect for GPs than I ever thought I would. Definitely one of the toughest jobs in medicine, far moreso than specialis

I am a CCFP-EM working in a tertiary care hospital in BC doing full time emergency medicine. We teach medical students and residents including the occasional 5 year elective resident. I do not do any

True, but the good ones have already given the ASA, Plavix, Lovenox, and possibly TNK by the time you're consulted. I did arrange once for rescue PCI in the middle of the night. That was cool.

And that after x number of years of exclusive EM, most licensing bodies (CPSO etc.) consider that CCFP-EM "out of scope" to practice FM in a walk-in clinic, let alone in family practice, and requires them to do some prescribed supervised retraining of some sort before they can add-back any kind of non-EM practice.

 

(I think it is x=ten years, but would recommend not quoting me on that.)

 

Which, I guess, from a long-term career flexibility perspective, is better than not having that option at all. Although rumour has it that FRCP-EM is treated pretty much the same way if they find themselves at a career crossroads, so I guess that's not much of a distinction if that is true.

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that's what i'm considering,

 

family medicine with a mix of EM, prob in a smaller community

 

i'm also looking into doing part-time at urgent care centres

 

 

i thought the difference between FRCPC and CCFP programs is that FRCPC involves more in-depth research and academic components whereas CCFP-EM is really for community practice

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Thanks for the comments everyone.

 

I think some of them were addressed in the post. If they weren't, you might want to check back. There have been a lot of very insightful comments from some very legitimate people (several CCFP-EM's, two FRCPC program directors).

 

http://boringem.org/2013/05/27/frcpc-or-ccfp-em-what-is-best-for-you/

 

It's definitely a discussion with a long history, but I can't see it changing any time soon. Canada's health resource needs for the ER currently seem to require every physician with EM training to even meet capacity in tertiary care centers these days. There's definitely no issue getting a job.

 

-brent

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Canada's health resource needs for the ER currently seem to require every physician with EM training to even meet capacity in tertiary care centers these days. There's definitely no issue getting a job.

 

To follow up on that, at CAEP's annual conference this year (CAEP = Canadian Association of Emergency Physicians) there were a lot of hospitals recruiting. By my count: Van Gen, Royal Vic, Fraser Health, Interior Health, Calgary, Ottawa, and some places in Ontario. There are certainly other places recruiting but they just didn't go to CAEP this year. The ER locum companies also have a bunch of jobs open.

 

Most of the people in the year ahead of me will be starting staff jobs in downtown Toronto in July, and I think I can predict with a fair degree of accuracy where most of the people in my cohort will be working in July 2014.

 

So right now the ER market is really good (especially as compared with ortho, NSx, CSx, nephro, etc). What it will be like for the med students participating in CaRMS this year or for those matriculating to med school this fall will be anybody's guess.

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How did the panel discussion go regarding the future of the dual EM certification at the CAEP conference? Any political will to do something?

 

To follow up on that, at CAEP's annual conference this year (CAEP = Canadian Association of Emergency Physicians) there were a lot of hospitals recruiting. By my count: Van Gen, Royal Vic, Fraser Health, Interior Health, Calgary, Ottawa, and some places in Ontario. There are certainly other places recruiting but they just didn't go to CAEP this year. The ER locum companies also have a bunch of jobs open.

 

Most of the people in the year ahead of me will be starting staff jobs in downtown Toronto in July, and I think I can predict with a fair degree of accuracy where most of the people in my cohort will be working in July 2014.

 

So right now the ER market is really good (especially as compared with ortho, NSx, CSx, nephro, etc). What it will be like for the med students participating in CaRMS this year or for those matriculating to med school this fall will be anybody's guess.

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Just wanted to update on this thread and bring this to a conclusion. I will be doing a plus one year in emergency medicine, and will probably be doing that solely. I am pretty happy with that, and am glad that in the end, the 5 issues I have raised with the specialty of family medicine have been rectified with this one year of extra training.

 

So happy for you. There are enough miserable people in the world that it is good that you wont be adding to it.

 

While I have respect for family physicians myself, working with some amazing rural family doctors, I myself am not interested in the family medicine route. I too am interested in emerg med and am thinking the 5 year royal college route in large to avoid the 2 years of family medicine training that I wouldnt use knowing I want emerg.

 

Again glad that you are happy but too bad you didnt get to see some real awesome rural docs in their realm. There are great family physicians out there but to each his own.

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Just wanted to update on this thread and bring this to a conclusion. I will be doing a plus one year in emergency medicine, and will probably be doing that solely. I am pretty happy with that, and am glad that in the end, the 5 issues I have raised with the specialty of family medicine have been rectified with this one year of extra training.

 

It's funny - after doing clerkship rotations in family medicine, I have far more respect for GPs than I ever thought I would. Definitely one of the toughest jobs in medicine, far moreso than specialists. Time consuming, poorly paid, and despite how frustrating some patient encounters are, you always have to keep an eye out for red flags that something serious might be going on, even when you just want to move onto the next patient.

 

And there is constant discussion of how we can convince more medical students to go into family medicine. It seems that a good proportion of those that I talk to that are interested in doing family medicine have a +1 year in mind already.

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I too am interested in emerg med and am thinking the 5 year royal college route in large to avoid the 2 years of family medicine training that I wouldnt use knowing I want emerg.

 

Probably not the best reason to do a 5 year program over a 2+1... the majority of patients you'll see in emergency medicine will be similar to what you see in family medicine, the exceptions are the acute cases. People choose to do the five year usually for other reasons - academic interests, research, special training, etc

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Probably not the best reason to do a 5 year program over a 2+1... the majority of patients you'll see in emergency medicine will be similar to what you see in family medicine, the exceptions are the acute cases. People choose to do the five year usually for other reasons - academic interests, research, special training, etc

 

seems like at least 50% on my rotations where just the same sort of thing I did on my family medicine rotation - that is exactly why I thought you could do emerg after only a single additional year. Otherwise it makes no sense.

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Probably not the best reason to do a 5 year program over a 2+1... the majority of patients you'll see in emergency medicine will be similar to what you see in family medicine, the exceptions are the acute cases. People choose to do the five year usually for other reasons - academic interests, research, special training, etc

 

Plus if you ever want to have a nice cushy part time retirement day job, you can always fall back on office family. Royal College ER is stuck with ER.

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While I have respect for family physicians myself, working with some amazing rural family doctors, I myself am not interested in the family medicine route. I too am interested in emerg med and am thinking the 5 year royal college route in large to avoid the 2 years of family medicine training that I wouldnt use knowing I want emerg.

 

:rolleyes:

 

Not to pile on, but this strikes me as a very ignorant thing to say, especially for a student not even yet in clerkship. What do you think those 2 years consist of? You'd be doing much of the same off service stuff, and given that 80% or more of emerg visits are a lot closer to walk-in clinic stuff those family med rotations would be quite useful. Emerg is not all about big acute stuff, and even then it doesn't take an extra two years to diagnose an MI.

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:rolleyes:

 

Not to pile on, but this strikes me as a very ignorant thing to say, especially for a student not even yet in clerkship. What do you think those 2 years consist of? You'd be doing much of the same off service stuff, and given that 80% or more of emerg visits are a lot closer to walk-in clinic stuff those family med rotations would be quite useful. Emerg is not all about big acute stuff, and even then it doesn't take an extra two years to diagnose an MI.

 

even if you found the MI it is cardiology that actually does something about it :)

 

Heck most of the time they are direct transfers for a serious MMI - right from the paramedics.

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interesting how Maslow's hierarchy of needs is ever evident today as it was when he first came up with it.:)

 

Agreed

 

Plus if you ever want to have a nice cushy part time retirement day job, you can always fall back on office family. Royal College ER is stuck with ER.

 

If the 2+1 emerg route is shorter and more broad in training with graduates that can fall back on FM at any time, then why would anyone want to do the 5 year Royal College EM?

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Agreed

 

 

 

If the 2+1 emerg route is shorter and more broad in training with graduates that can fall back on FM at any time, then why would anyone want to do the 5 year Royal College EM?

 

endless debates about that. I mean first off if you get EM directly then you have EM - the 2+1 route is not guaranteed by a long shot so if you really want emerg why not attempt it. You get a lot of more exposure of course, you do a lot more research. You are more likely to get a job at a tertiary care centre at you are viewed as better trained by many (right or wrong). You have to fellowships on top of your emerg 5 year to be even more specialized perhaps in areas you are interested in. The FM route is more broad in general but not more board in the area of emerg - some people think you don't get enough exposure to some areas in the 2+1.

 

I find it interesting that emerg is 4 years in the US - and they get more violent trauma than we do and 5 years here. Other than 5 being a nice round number I am not sure why there is that difference. It is going to be interesting under the newer competency training programs coming out how that will all work out.

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endless debates about that. I mean first off if you get EM directly then you have EM - the 2+1 route is not guaranteed by a long shot so if you really want emerg why not attempt it. You get a lot of more exposure of course, you do a lot more research. You are more likely to get a job at a tertiary care centre at you are viewed as better trained by many (right or wrong). You have to fellowships on top of your emerg 5 year to be even more specialized perhaps in areas you are interested in. The FM route is more broad in general but not more board in the area of emerg - some people think you don't get enough exposure to some areas in the 2+1.

 

I find it interesting that emerg is 4 years in the US - and they get more violent trauma than we do and 5 years here. Other than 5 being a nice round number I am not sure why there is that difference. It is going to be interesting under the newer competency training programs coming out how that will all work out.

 

Makes sense. Thanks for the clarification rmorlean

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Probably not the best reason to do a 5 year program over a 2+1... the majority of patients you'll see in emergency medicine will be similar to what you see in family medicine, the exceptions are the acute cases. People choose to do the five year usually for other reasons - academic interests, research, special training, etc

 

Sorry I should have made it more clear that I was half joking/ half serious ... I am interested in the 5 yr due to reasons you said particularly the fellowship opportunities (i.e. critical care, trauma).

 

Being on rural family med rotation right now I guess I developed a bit of a bad attitude from some of the emotionally draining patients who have come in with 6 complaints on a list of paper and sucked out my soul as they go on about their sore toe, dry skin, forms to fill out and 3 more complaints. I have really enjoyed the rural emerg work and the lumps/bumps/lesion clinics though.

 

Beef

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:rolleyes:

 

Not to pile on, but this strikes me as a very ignorant thing to say, especially for a student not even yet in clerkship. What do you think those 2 years consist of? You'd be doing much of the same off service stuff, and given that 80% or more of emerg visits are a lot closer to walk-in clinic stuff those family med rotations would be quite useful. Emerg is not all about big acute stuff, and even then it doesn't take an extra two years to diagnose an MI.

 

Rude to say yes but not ignorant. At my school we have already done 2 months of family medicine rotations by now so as my earlier post said I have been exposed and familiar with some of the FM clinic work. I agree that emerg is exposed to walk-in clinic style patients but due to the nature of the ED people dont come in with 6 petty issues written down on a piece of paper in addition to all kinds of forms for you to fill out rather you get 1-2 complaints that can be dealt with as I fly in and out without even sitting down. So yes pre-clerkship but with enough clerkship-like experiences to form an opinion on what I like and dont like.

 

I do agree that FM work is helpful for the common presentations in the ED. I had almost a whole day last week in the ED that was sinusitis, colds and some ear aches.

 

Beef

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