Family Med + Emergency Medicine Fellowship

[drskmed]

I am considering doing an EM fellowship, more to learn more and get more experience. Anyone know what the pay is like being a full-time FM doing ER work exclusively? I imagine its in the upper 200's.

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[Ericslv]

Rural work usually makes more money. You will have a hard time finding work in an urban area. If your goal is to work rural and have more experience in the ER then it may serve you to do the fellowship. But if you expect to get a job in an urban area doing ER next to ER trained doctors you may be disappointed.

 

[styphon]

ER fellowship will not get into ER's that require EM board certification. This includes most urban areas.

To work in a rural/suburban ER (which most likely does not require EM board cert) experience will matter more than the EM fellowship.

The fellowship exists to make YOU comfortable, and does not help with salary/job options.

 

[PathoTurnUp1865]

ER fellowship will not get into ER's that require EM board certification. This includes most urban areas.

To work in a rural/suburban ER (which most likely does not require EM board cert) experience will matter more than the EM fellowship.

The fellowship exists to make YOU comfortable, and does not help with salary/job options.

Come to Oklahoma City, you'll see lots of FM docs in the ER.

 

[Doctor4Life1769]

EM fellowship is a waste unless you want more experience at the expense of $150-160K

 

[Yadster101]

Rural work usually makes more money. You will have a hard time finding work in an urban area. If your goal is to work rural and have more experience in the ER then it may serve you to do the fellowship. But if you expect to get a job in an urban area doing ER next to ER trained doctors you may be disappointed.

Then why do these urban areas hire PAs/NPs to work in the ER? Aren't boarded FM docs (w/ or w/o EM fellowship) wayyy better than a PA holding a 2 years masters degree?

 

[Ericslv]

Then why do these urban areas hire PAs/NPs to work in the ER? Aren't boarded FM docs (w/ or w/o EM fellowship) wayyy better than a PA holding a 2 years masters degree?

That is a very good question.
I'll try to answer it.

The PA is there to see the BS cases that should not be in ER in the first place. They get to bill ER rates and the physician groups or hospital gets to pay the PA, PA rates. About half what they would have to pay MD. PA and NP are there to save money and make money for the hospital.

All roads lead to the dollar. In your future career never forget that. Whenever you see something that doesn't make sense and everyone can see it can be done easier and with more common sense but is not being done that way remember that ALL ROADS LEAD TO THE DOLLAR. Follow the money and you will find the answer to almost every question that keeps you up at night.

That's why your medical education takes a 4 year undergraduate degree and then a four year medical school degree when just over the ocean in England, Germany or Holland they can do it in 6 years and for half the cost.

That's why when you become an MD and have to board certify and re-certify and re-certify and so on and so on, that's because some academic has figured out a way to make a very good living off of you forever.

All roads lead to the dollar.

 

[bashwell]

That is a very good question.
I'll try to answer it.

The PA is there to see the BS cases that should not be in ER in the first place. They get to bill ER rates and the physician groups or hospital gets to pay the PA, PA rates. About half what they would have to pay MD. PA and NP are there to save money and make money for the hospital.

All roads lead to the dollar. In your future career never forget that. Whenever you see something that doesn't make sense and everyone can see it can be done easier and with more common sense but is not being done that way remember that ALL ROADS LEAD TO THE DOLLAR. Follow the money and you will find the answer to almost every question that keeps you up at night.

That's why your medical education takes a 4 year undergraduate degree and then a four year medical school degree when just over the ocean in England, Germany or Holland they can do it in 6 years and for half the cost.

That's why when you become an MD and have to board certify and re-certify and re-certify and so on and so on, that's because some academic has figured out a way to make a very good living off of you forever.

All roads lead to the dollar.

This should be a new House of God rule.

 

[deleted6669]

Then why do these urban areas hire PAs/NPs to work in the ER? Aren't boarded FM docs (w/ or w/o EM fellowship) wayyy better than a PA holding a 2 years masters degree?

depends on the PA. typical new grad pa vs new grad fm doc, doc wins. someone who was a medic in a busy system for 10 years who became a pa and has spent the last 10+ years as an em pa seeing all levels of acuity and doing all procedures will run circles around a new family medicine physician in the ED. I precept pgy 1 to pgy-3 family medicine residents at 3 facilities and know this to be true.

 

[Ericslv]

depends on the PA. typical new grad pa vs new grad fm doc, doc wins. someone who was a medic in a busy system for 10 years who became a pa and has spent the last 10+ years as an em pa seeing all levels of acuity and doing all procedures will run circles around a new family medicine physician in the ED. I precept pgy 1 to pgy-3 family medicine residents at 3 facilities and know this to be true.

I don't entirely agree with you but at any level you should be thanking the doctors who chose to train you. Those doctor you just put down are the same ones that can run circles around you in practically any other segment of medicine. We don't need techs. We need well rounded doctors.

 

[deleted6669]

I don't entirely agree with you but at any level you should be thanking the doctors who chose to train you. Those doctor you just put down are the same ones that can run circles around you in practically any other segment of medicine. We don't need techs. We need well rounded doctors.

I agree these guys could run circles around me in clinic or on a hospitalist service. I respect the heck out of folks who have the time and commitment to do this. doesn't mean someone with less than a year total in the ER between med school and residency trumps an em pa (and I don't just mean me) with 10+ years on the job...and a good em pa isn't a tech...we run departments solo...doing it right now in fact....yes, it's a small rural dept. they staff either a doc or a pa here interchangeably. no difference in scope of practice.

 

[Doctor4Life1769]

I agree these guys could run circles around me in clinic or on a hospitalist service. I respect the heck out of folks who have the time and commitment to do this. doesn't mean someone with less than a year total in the ER between med school and residency trumps an em pa (and I don't just mean me) with 10+ years on the job...and a good em pa isn't a tech...we run departments solo...doing it right now in fact....yes, it's a small rural dept. they staff either a doc or a pa here interchangeably. no difference in scope of practice.

So you can run a trauma as effectively? Do FAST exams and all?

Sure, you may be more facile with the lay of the land and types of services provided, but a new physician would still be better than a PA when it comes to complex issues at hand. Sure, they may initially struggle with issues of unfamiliarity, but with time, they'd quickly supersede you.

It's not a knock against you or the PA profession; however, because it is true.

I love how a PA is making an argument that the CRNAs and NPs have been making for some time now. I knew it, even PAs want in on the enchilada. AAs are next, anesthesiologists better beware.

 

[Doctor4Life1769]

depends on the PA. typical new grad pa vs new grad fm doc, doc wins. someone who was a medic in a busy system for 10 years who became a pa and has spent the last 10+ years as an em pa seeing all levels of acuity and doing all procedures will run circles around a new family medicine physician in the ED. I precept pgy 1 to pgy-3 family medicine residents at 3 facilities and know this to be true.

Why the **** are residents precepting to YOU??
Poor training is going on for future physicians to be precepted by PAs.

 

[Ericslv]

Why the **** are residents precepting to YOU??
Poor training is going on for future physicians to be precepted by PAs.

Yet another reason why I have issue with medicine and FM. The powers that be have allowed erosion of the profession. Allowing sub-standard trained individuals to basically get on the job training and then claim they are better than a residency trained physician. Yet they make the residency trained physician jump through more hoops just to say they are BC / MOC etc.

Those ER docs could have just as easily hired a well trained FM but because of money they chose to hire a PA.

 

[Doctor4Life1769]

Yet another reason why I have issue with medicine and FM. The powers that be have allowed erosion of the profession. Allowing sub-standard trained individuals to basically get on the job training and then claim they are better than a residency trained physician. Yet they make the residency trained physician jump through more hoops just to say they are BC / MOC etc.

Those ER docs could have just as easily hired a well trained FM but because of money they chose to hire a PA.

Well, to be fair, BC EM trained physicians have more leverage in terms of type of ER and location.
FM trained ones work in smaller ERs and usually non-trauma centers (or possibly some Level 2/3 centers)

 

[Ericslv]

Well, to be fair, BC EM trained physicians have more leverage in terms of type of ER and location.
FM trained ones work in smaller ERs and usually non-trauma centers (or possibly some Level 2/3 centers)

I was referring to PA being trained on the job when there are perfectly capable FM's than can do a better job.

 

[deleted6669]

So you can run a trauma as effectively? Do FAST exams and all?

yup. been ATLS certified for over 20 years and teach trauma courses myself...put in chest tubes, etc. 10 years as a medic in busy systems and >20 years as an em pa and you see a lot of trauma and do a lot of procedures....certainly more than an fm doc right out of residency....don't get me wrong, I don't disrespect fm docs. they are great at what they do. for most of them though that doesn't include full time emergency medicine. I'm willing to step aside for a FM doc who has functioned for a few years as an em attending. no problem, but a new grad fm doc....sorry, no. get some input from Makati, one of the mods here. he was an em pa for years and went back to medschool. he can tell you what a good em pa can do.

 

[deleted6669]

Why the **** are residents precepting to YOU??
Poor training is going on for future physicians to be precepted by PAs.

because many of my attendings haven't done a procedure in years....it's not uncommon for my attendings to ask me to work on their kids because they know I do procedures more often than anyone else there. one of my em attendings recently told me he hasn't done an I+D in over a decade....at my last pa job I ran an em procedures rotation for the incoming FM residents to get them up to speed. several of them are still friends. you need to be able to learn from anyone regardless of the initials after their names. if you have never learned anything from an er nurse you haven't been paying attention...

 

[Doctor4Life1769]

because many of my attendings haven't done a procedure in years....it's not uncommon for my attendings to ask me to work on their kids because they know I do procedures more often than anyone else there. one of my em attendings recently told me he hasn't done an I+D in over a decade....at my last pa job I ran an em procedures rotation for the incoming FM residents to get them up to speed. several of them are still friends. you need to be able to learn from anyone regardless of the initials after their names. if you have never learned anything from an er nurse you haven't been paying attention...

There's a difference between being a preceptor for a procedural rotation and being an actual preceptor/attending for an EM rotation.

Of course I can learn procedures from anyone. A monkey can learn to do procedures with time. That's not usually the point, though.

I highly doubt an EM attending asked you to perform an I/D because he hadn't done it in forever. I'm sure he was busy overseeing care of several and didn't want to fool around with a simple procedure when he could be seeing more or following up on stuff.

 

[Ericslv]

because many of my attendings haven't done a procedure in years....it's not uncommon for my attendings to ask me to work on their kids because they know I do procedures more often than anyone else there. one of my em attendings recently told me he hasn't done an I+D in over a decade....at my last pa job I ran an em procedures rotation for the incoming FM residents to get them up to speed. several of them are still friends. you need to be able to learn from anyone regardless of the initials after their names. if you have never learned anything from an er nurse you haven't been paying attention...

Sounds like your ER has an attending issue. Or perhaps they know procedures such as that are not nearly as important as diagnosis and therefore give those to you because they are the experts and choose to spend their time diagnosing.

 

[Doctor4Life1769]

Sounds like your ER has an attending issue. Or perhaps they know procedures such as that are not nearly as important as diagnosis and therefore give those to you because they are the experts and choose to spend their time diagnosing.

Exactly my point.

 

[Ericslv]

Then why do these urban areas hire PAs/NPs to work in the ER? Aren't boarded FM docs (w/ or w/o EM fellowship) wayyy better than a PA holding a 2 years masters degree?

Because they can pay them less.

 

[septoplasty]

depends on the PA. typical new grad pa vs new grad fm doc, doc wins. someone who was a medic in a busy system for 10 years who became a pa and has spent the last 10+ years as an em pa seeing all levels of acuity and doing all procedures will run circles around a new family medicine physician in the ED. I precept pgy 1 to pgy-3 family medicine residents at 3 facilities and know this to be true.

Wait, what?

How are you precepting a physician? Lol

The fallacy of this is what me as a "young" physician faces as an attending when I'm asked to sign notes of mid-levels who have been "doing this longer than I've been alive" report. Repeating the same thing over and over in practice is not any better than someone who is fresh out of an academic training.

Also, the ACGME doesn't allow supervision by non-physicians. So:

1. BS you precept
2. The rotation isn't ACGME Compliant.

 

[Ericslv]

Wait, what?

How are you precepting a physician? Lol

The fallacy of this is what me as a "young" physician faces as an attending when I'm asked to sign notes of mid-levels who have been "doing this longer than I've been alive" report. Repeating the same thing over and over in practice is not any better than someone who is fresh out of an academic training.

Also, the ACGME doesn't allow supervision by non-physicians. So:

1. BS you precept
2. The rotation isn't ACGME Compliant.

Basically he got on the job training from DOCTORS and now he is badmouthing them. In my opinion we should never train PA's an NPs. This way they can't come back in 5 years and pretend like they know so much when they don't.

 

[betamale]

I am considering doing an EM fellowship, more to learn more and get more experience. Anyone know what the pay is like being a full-time FM doing ER work exclusively? I imagine its in the upper 200's.

$170-$260/hr...about 300k-$450k~ full time among us recent fellowship graduates. Plenty of jobs everywhere. Just got a job ad from 3 places that usually only take ABEM docs but are now taking ABFM docs because of shortages. My med director are warming up to ABFM docs with EM Fellowship.

 

[sotto]

$170-$260/hr...about 300k-$450k~ full time among us recent fellowship graduates. Plenty of jobs everywhere. Just got a job ad from 3 places that usually only take ABEM docs but are now taking ABFM docs because of shortages. My med director are warming up to ABFM docs with EM Fellowship.

Loved this insight! Just saw your response. I’m a new PGY-1 family medicine resident. I hope to do an EM fellowship some day. Would you mind providing me some mentorship as I go through residency?
I’ll really appreciate.