View Full Version : Emergency Medicine
12-02-2001, 05:13 PM
Can anyone tell me the difference between the 5 years emergency program and the PGY3 emergency program after the 2 years family medicine? Can you still work full time emergency physician with the PGY3 or you have to do family and some emergency? I assume that the 5 year residency program would be for centers such as Toronto or other academic/teaching hospitals?
12-02-2001, 07:20 PM
Competition. If you want to work solely as an ER doc in a big city, do the 5yr program. PGY3 is only good for rural medicine or smaller hospitals. The larger places like downtown Toronto will be looking to hire docs with 5 years in emerg.
12-02-2001, 08:22 PM
Here's something I wrote about EM via the Family Med/CCFP (Emerg) certification a while back. I think Strider2004 is correct in stating that hospital discrimination is the biggest obstacle to practicing EM with a CCFP alone, versus the full five year FRCPC EM degree.
With a Family Med/CCFP certification, you should be able to work as either a full-time GP, a full-time EM doc, or somewhere in between as long as you can find a workplace (read: hospital or private practice) that supports it. I would suspect that this is most possible outside of the large urban centers in the rural areas where there is a demonstrated need for both EM docs and GPs.
UBC, Med 3
In a lot of ways, Emerg very closely mirrors elements of Family Practice, particularly in the more rural areas where referring to specialists isn't that easy. Emerg docs need to be very well-rounded in most/all areas of medicine to some degree, and to have the confidence and knowledge of their limitations to refer outside their department when appropriate.
Not surprisingly, knowing that FP is much like Emerg, there is a one year Emergency medicine fellowship that is available to family practitioners, the CCFP (Emergency Medicine). I believe CCFP stands for Canadian College of Family Practitioners. So, despite the "doom 'n gloom" of trying to match into the five-year Emergency Medicine residency directly through CaRMS (with an abysmal match rate of 27% into the first-ranked program, and 57% match rate into Emerg at any location: www.carms.ca/stats/stats21.htm#first (http://www.carms.ca/stats/stats21.htm#first)), one could also match into Family Practice and do the two years, and then do an additional one year CCFP. Family Practice is a much easier match than Emerg directly out of med school.
The disadvantage of the CCFP is that although the fellowship itself is offered in, I believe, every single Canadian province, not every hospital recognises it. For example, in Vancouver, the CCFP is recognised by UBC hospital and St. Pauls Hospital. However, one cannot work at Vancouver General Hospital without the full 5-year specialty, and CCFP holders are generally not accepted at Royal Columbian Hospital either.
Outside of large urban centers, I believe that your chances of being able to work with just the CCFP should be near or at 100% due to the extreme shortage of EM docs. Apparently there have also been large studies that show the outcome of patients under the care of Emerg docs who have done either the full five year program, or the three year CCFP program to be equivalent after five years of EM practice.
12-28-2001, 05:27 PM
Here's a neat article I stumbled upon from the Canadian Journal of Emergency Medicine regarding the reasons senior medical students choose EM as a career.
UBC, Med 3
12-17-2003, 06:47 AM
How competitive is it to get the 1 year EM fellowship? Lots of competition? Or relatively easy?
12-17-2003, 07:42 AM
Depends where you are. In Toronto it's hyper competitive, because there's only 6 positions each year, and a couple of hundred FP residents, of which a sizeable portion compete for those 6 positions, not to mention people who have graduated from FP residencies at other schools, or who are looking to upgrade, who are also competing for those 6 spots. Alternatively, in some other schools, the ER 3rd year spots are first-call spots for their OWN graduating FP residents, so they are usually filled internally and not from competition from other schools or practising docs. This is not the case in Toronto.
FWIW, I've been working at a downtown Toronto teaching hospital in the ER for about a month now, and if I recall correctly, only 1 of the twenty or so docs who take shifts there has the FRCP. And only a handful even have the PGY3. Many are family docs (or older GP's) who have just gravitated towards working emerg. You probably wouldn't have much trouble working emerg even without the R3 year, not to mention the 5 year FRCP (which is focused on a lot of administration and research in the last two years).
Hope this helps
12-18-2003, 08:02 AM
You have to be careful in saying that you don't need the PGY-3 year... In fact the jobs are not as plentiful as they used to be in the Toronto emergency departments... as such most demand at least the CCFP(EM) year.
I am currently doing the FRCP programme at UofT. I think that the FRCP is important if a) you want to have a parallel career (most end up having on in EP (or burning out early) in academia (Education or Research)... and b) if you want to work at a large academic hospital in some of the major cities. Some of the traditionally large academic hospitals are not considered academic EDs... i.e. the academic EPs tend to stick together where the practice group can provide adequate support for the academic career. That said, a number are now starting to work at the community hospitals as well.
I would strongly suggest doing at least the CCFP(EM) if you are interested in doing emerg... there is a lot of specialty training that you get in that year... trauma, toxicology, cardiology, ICU etc. that you definitely don't get in family medicine. I personally can't imagine running a department and taking on that responsibility without the extra training.
EM is very different than family medicine. Sure sometimes the minor stuff is the same but you but that is a minority (maybe 1/4) of what comes through a big hospital's emerg.
My two cents... got to go work.
12-18-2003, 10:36 AM
You know, there are three docs that I know did not do the fellowship EM thing and work at ST. Mikes, a trauma hospital in downtown toronto.
Actually, one of them only did a two year family medicine residency. I would be careful about your assumptions. Anyone can work in a big city ER, the feelowship people are wasting their time.
12-18-2003, 11:09 AM
Those 3 docs may well be an exception, or may have started their careers many years back. Futhermore to say doing a fellowship is a waste of time is a pretty foolish statement. That's akin to saying a surgery fellowship to strengthen your operative skills is a waste of time.
12-18-2003, 12:31 PM
I believe the current undergrad emerg program coordinator at UWO is a 3 year emerg doc. At any rate, my understanding is that many/most of the staff at St. Joseph's (a downtown London Hospital) are 3-year emerg docs.
When you think about it, with only 20 spots for the program every year and an average lifespan for an emerg doc being 10 years, there is nowhere near enough Royal College (aka 5-year) trained emerg docs to fill all the need for emerg docs in this country - in fact, one of the emerg docs here was recently telling us that there is currently only ONE 5-year FRCPC certified emerg doc in the whole province of Newfoundland. . . and he hadn't been there long! The "specialty" of emergency medicine is relatively new, I believe the specialized residency program for emergency medicine dates back to only the early 80s. Before then, emergency departments were entirely covered by off-service physicians and GPs. The idea behind the 5 year FRCPC program was not to replace the traditional off-service EM physician, but to supplement him/her with a "specialist" who was an expert in resuscitation and other aspects of emergency medicine.
12-18-2003, 02:16 PM
Yes... there are a couple of EPs at St. Mike's from before there was an EM qualification... Right now they are not hiring at St. Mike's... rumour is there may only be one spot max available at the end of this year (there are 5 FRCPs graduating this year in T.O.)... And of course there are CCFP(EM)s working at St. Mike's.
I did not say you need extra qualifications to get an EM job... but I am saying it would be foolish to expect that you would get a job these days at a large EM academic centre without any extra qualifications. Of course, once upon a time you didn't need it because it didn't exist or was so new there weren't enough people with the qualifications to supply the demand. This has changed in places like Toronto. Most EDs are staffed mainly with people with the CCFP(EM) qualification.
12-18-2003, 03:56 PM
What is that, how can you be an expert in that and not be a cardiologist. It's a silly specialty, because its really not a specialty.
Are General specialists? Or are they really "special" generalists?
12-18-2003, 04:46 PM
I'd partially agree with you cracked, but I don't really understand your terminology. What are you referring to with the term "general specialists"? Are you referring to general internists or the outdated term general practitioner?
I think the problem is that at some point in the mid-twentieth century, the term "specialist" became a term denoting respect rather than utility in medicine. Am I the only one who finds it kind of funny that we give MORE respect to someone who decides to ignore all but one or two organ systems?
I think you all have to look at this historically (at least how I understand medical history). 100-150 yrs ago you only had Physicians and Surgeons, with Physicians being the far more respected of the two (I believe in Britain they were still calling surgeons 'Mr.' until recently.) Then, with the explosion in knowledge some academic centres started offering medical "specialty" courses where a GPs would become more proficient at a subject such as cardiology. They would still practice as GPs, but offer second opinions to their fellow GPs at a slightly greater fee, partially to cover the cost of their extra training. Sometime around the end of WWII, many of these specialties began formally registering themselves and preparing formal training programs. With the explosion of medical knowledge, GPs were finding their 4 + 1 years of training were inadequate to make them complete experts at all the nuances SVT, Wolf-Parkinson White, and the like and specialists became a necessity for the health care system. Throughout the 1950s and 1960s and at a time when the Canadian Health Care system and its fee codes were in a state of birth, specialists became more and more necessary and as they seemed to be the person your doctor went to for advice and info, they gathered more respect from the public than GPs. This, combined with the accepted fact specialists need to invest more time and money for training, led the government to set specialist consult fees WAY higher than GP fees in fee schedules during the 1970s and 1980s. This led to less applicants to general practice in 1980s and 1990s, and a change of the system to call general practictioners "family medicine specialists" to help bolster their image and prevent a shortage of GPs in 1990s and 2000s. But as renumeration in family medicine generally stayed much poorer than in specialties, and (some) med students maintained the impression that only inferior colleagues went into family* medicine, family medicine remained as unpopular or even more so then general practice and we arrive at the current crisis.
Really, when you think about it, we have everything backwards now. So we decide to send the 2-year trained family medicine doc to staff the internal (incl cardiology, respirology, GI, nephro, everything) AND emergency medicine departments of Hospitals in Rural/northern Ontario, where they daily meet critical life or death decisions without any backup in terms of colleagues or expensive equipment. Then we give 5,6,7 yrs worth of training to the hand & upper limb specialist who focuses on and only needs to know about the pinkie finger, then give them a multimillion dollar infrastructure with MRIs, CTs and numerous other 'specialists' to consult. Am I the only one who finds that odd?
Maybe we should be making the 'specialties' 2 year programs and rural emergency medicine the 7 year program?
And I got another question for you, cracked, which you might not see as being related. MDs are key to survival for trauma victims. . . so why doesn't an MD ride along in an ambulance?
*This is not the author's opinion but the author would certainly argue that opinion exists in medical schools.
12-21-2003, 11:19 AM
Well, first, patients want to see specialists.
Family docs in northern/rural Ontario don't do coronary angiography, bronchoscopy, endoscopy or plan dialysis. So they really aren't acting as such specialists in northern/rural Ontario. The on site internist usually does these things. There is usually at least one in a hospital like that.
Family docs in rural and northern areas need specialists, they often need their hands held through something as simple as a distal radius fracture. (personal experience)
12-21-2003, 06:58 PM
Hence my argument in another thread that we have everything backwards: rural physicians should be getting the 7 years of training, and specialists in an academic centre 2 years of training.
Of course I'm being somewhat facetious with that - I don't seriously think neurosurgery programs should be only 2 years.
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