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I think hking03 is more getting at the fact that once you do the 2+1 and practice for a few years in EM only, transitioning back to traditional FM is not exactly easy. You may be technically qualified to work as an FP, but if you're out of that setting for even 5 years, you're probably not competent without a good amount of supplementary education, ideally with some supervision.

 

I also wouldn't count on being able to use the exam challenge route to do full EM care in most centres. To get the number of hours you need without a +1, you'd mostly be talking working at small community hospitals with a very different combination of resources, patient population and overall levels of acuity than Emergency Departments staffed only by Emerg Docs (whether 5-year or 2+1 certified). Unless a center is really hurting for EM docs, I don't see many of them taking on a practitioner who's only experience is in small community hospitals.

Oh yeah for sure, I should have been clear that doing 1-2 FM days with EM shifts thrown on top, that way you're not out of the loop. 

 

I can see what you mean about the exam challenge route vs. getting the +1 etc. Smaller communities are more than fine for myself thankfully. 

 

Or theres always a +1 in the US in some form I imagine, haven't looked much into that but i wouldn't be surprised if theres a fellowship of sorts that overlaps.

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Oh yeah for sure, I should have been clear that doing 1-2 FM days with EM shifts thrown on top, that way you're not out of the loop. 

 

I can see what you mean about the exam challenge route vs. getting the +1 etc. Smaller communities are more than fine for myself thankfully. 

 

Or theres always a +1 in the US in some form I imagine, haven't looked much into that but i wouldn't be surprised if theres a fellowship of sorts that overlaps.

 

That's fair, but also easier said than done. A traditional FM practice can't often be sustained on 1-2 days a week - not enough time to keep a decent patient roster, not enough money to pay for clinic space or staff, not enough availability for those patients to have sufficient access. Walk-in clinic or nursing home care might be feasible though. Booking that much time off in a week from ER availability might also be a challenge, though that'll depend on the department. Basically, doing the 2+1 and having a foot in both worlds is something that gets thrown around a lot by students (myself included) interested in the possibility, but when you talk to practicing physicians, very few of them do this.

 

If you stay in smaller communities, you don't need a +1 at all, though I suppose there's nothing stopping you from getting one. More letters behind the name can't hurt!

 

Not sure what's available in the US, Family doctors there don't always have the kind of opportunities we do here. Not sure that such training would be accepted in Canada either - the CFPC eligibility requirements don't make much mention of foreign credentials.

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That's fair, but also easier said than done. A traditional FM practice can't often be sustained on 1-2 days a week - not enough time to keep a decent patient roster, not enough money to pay for clinic space or staff, not enough availability for those patients to have sufficient access. Walk-in clinic or nursing home care might be feasible though. Booking that much time off in a week from ER availability might also be a challenge, though that'll depend on the department. Basically, doing the 2+1 and having a foot in both worlds is something that gets thrown around a lot by students (myself included) interested in the possibility, but when you talk to practicing physicians, very few of them do this.

 

If you stay in smaller communities, you don't need a +1 at all, though I suppose there's nothing stopping you from getting one. More letters behind the name can't hurt!

 

Not sure what's available in the US, Family doctors there don't always have the kind of opportunities we do here. Not sure that such training would be accepted in Canada either - the CFPC eligibility requirements don't make much mention of foreign credentials.

 

Yeah you're probably very right, which makes decision making harder hah. Although working 2 days FM is totally feasible in a group practice, but besides the point as you pointed out the difficulty of EM scheduling.. Oh well, still nice to know there is options for variability even if hard to pull off!

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Yeah you're probably very right, which makes decision making harder hah. Although working 2 days FM is totally feasible in a group practice, but besides the point as you pointed out the difficulty of EM scheduling.. Oh well, still nice to know there is options for variability even if hard to pull off!

One group that I worked with in a smaller community (population 6000) ran the hospital. So, they would round on their patients admitted to the ward in the morning, then head to clinic for the day. One day a week they would do a 24 hours shift in the emergency department w/ or w/o a post call day afterwards.

 

It was a really nice way to practice, and most of the docs worked 3-4 days in clinic and 1 day (24 hour shift) in the ED while still seeing their patients in the hospital each day. I feel like this set up is more likely to occur in smaller communities, and even then is subject to a number of factors...

 

I think you have to be in an understanding group practice and patient population if you only work a couple days in clinic and then a couple days in the ED because your patients will need to be seen when you are not in clinic and if they end up spending more time with the patient than you... it might be better for the patient to be with that doctor instead. I do know of docs who split up patient loads so that you work part time, but again... this would only arise if you had people interested in doing this.

 

Anyways, just an example of a group practice that sort of fits with your goals.

 

Good luck

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that doesn't exactly look all that restrictive mind you. Oh no - you have to practise at least two years in the field you were really interested in somewhere in the province :)

 

unless I am missing something.

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If I may ask, why was there this huge buzz about a shortage of family doctors in Canada if the number of FM residency positions account for nearly half of all specialties?

The spots typically don't all get filled every year (most years) and there's a problem of distribution. Many family med doctors tend to stick in large metropolitan areas like the GTA, Greater Vancouver, while leaving some rural and remote areas of the country without any GPs.

 

Even in the cities, many GPs work part time and it's hard to find ones that take in new patient. I was told by a GP that most GP she knows only work 2-3 days in the clinic. Most do other things on other days (re: flexibility of the practice), but it still means they're not seeing patients in their office, and that's what people think about when it comes to family med.

 

There's also a supply-demand aspect. Demand for GP services is high since they act as gatekeepers in to the health care system.

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The spots typically don't all get filled every year (most years) and there's a problem of distribution. Many family med doctors tend to stick in large metropolitan areas like the GTA, Greater Vancouver, while leaving some rural and remote areas of the country without any GPs.

 

Even in the cities, many GPs work part time and it's hard to find ones that take in new patient. I was told by a GP that most GP she knows only work 2-3 days in the clinic. Most do other things on other days (re: flexibility of the practice), but it still means they're not seeing patients in their office, and that's what people think about when it comes to family med.

 

There's also a supply-demand aspect. Demand for GP services is high since they act as gatekeepers in to the health care system.

 

It's not quite true that spots in FM don't get filled. They generally don't all get filled in the first round, but because unfilled positions stick around to the second round, they usually do end up filled (Quebec being the usual exception). Distribution is definitely a factor though!

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