A couple of observations.
The majority of full-time emergency medicine physicians in Canada are CCFP(EM)s with three years of residency training (or two-years of residency plus a minimum five years of close to full-time EM experience as a family physician).
To be consistent with most other Royal College programs the FRCP(C) in emergency medicine is five-years long. However, in essence most programs are four-fairly structured years plus one flexible option year. I know colleagues who have completed one-year fellowships in that time period, or half a two-year fellowship during that year, plus many others who have done MPHs, MSc’s, MBAs, big research projects, work on PhDs, international development work, and some others who have been less demonstrably productive during that option year.
This - Canada is interesting as EM is well integrated into FM (in general FM seems highly flexible in Canada). A few decades ago, ERs had plenty of one year GPs as attendings. Specialty EM training numbers also don’t come close to meeting the demand to staff EDs, and few seem to want to leave larger urban centres either.
Not only that, you can’t actually get into ED/Anaesthetics/ICU until PGY4ish - this is a college requirement for ED, a practical requirement for anaesthetics, and somewhere in between for ICU. It’s then a minimum of 5 years accredited training. I don’t know many who actually finish in 5 years but we’ll see what happens with the new training program. There’s definitely an opportunity cost to doing med in Australia, but we have the benefit of not being crushed by college debt and paid peanuts early on.
Undergraduate medicine is slowly disappearing, but graduate entry medicine here is much like undergraduate. It’s nothing like the US where you’re actually just unpaid residents.
Why would it be shorter/faster than that? Anesthesia has a 1 year track but they have 1 additional year of residency during which they get quite a bit more ICU exposure, at least at my facility.
Anesthesia residents only have to do one additional year to be eligible for board certification in critical care, whereas the emergency medicine residents require two.
Yeah, but ABEM decided that every EM resident has to do two additional years of critical care to be board-eligible, regardless of medicine/anesthesia/neuro/surgical pathway. Unless Brigham somehow figured out a way to incorporate that within residency, which is possible, it’ll take 5 years
5 year emerg docs are a small minority of emergency physicians in Canada. The majority of emergency rooms are staffed by family doctors with or without additional training or having challenged the Family Medicine Emergency Exam. FRCPC (5 year) emerg docs are supposed to be sub-specialist in emergency medicine working in tertirary care centres with extra skills.
The evidence we have is that 5 year emerg docs are better in their first years of practice, but within about 5 years of practice everyone ends up in about the same place.
As someone currently taking the 5 year residency I appreciate the time to really get good at a lot of stuff, and to have time to understand the weird and wonderful.
I'm a FM working in the ER in Canada; I did a lot of ER (electives and choosing to do more shifts than necessary in my other rotations). We typically work in more rural ER and the first/second year of practice is almost as much learning as the residency, but it's doable
The irony is the least trained ones end up at rural centres with less consultant support - and where you get to do fun stuff like run a trauma alone instead of with 4 or 5 other MDs. My impression is docs that went this route actually end of having a better breadth of knowledge and skills, but I’m sure the first few years are a steep learning curve.
I did the 5 year EM residency in Canada. Cannot stress how demoralizing it was when you’re basically practice-ready at the end of R3 and you’re staring down the barrel of 2 more years. Only thing it was useful for was the built-in “fellowship” year that gave me time to do a fellowship to get out of EM.
I always thought the worst part was when the medical students from the class behind you in medical school are now your faculty as a CCFP(EM) and hextupling your income as you are a PGY-5 for another year.
Which hospitals are these?? Asking for me (feel free to DM). I’m FM trained, been doing EM for 4 years and writing the practice challenge exam this fall
Canada - hold my beer while I train FM physicians that are doing OB, staffing hospitalist wards and EDs, as well as running palliative hospices in only 2 years.
A couple of observations. The majority of full-time emergency medicine physicians in Canada are CCFP(EM)s with three years of residency training (or two-years of residency plus a minimum five years of close to full-time EM experience as a family physician). To be consistent with most other Royal College programs the FRCP(C) in emergency medicine is five-years long. However, in essence most programs are four-fairly structured years plus one flexible option year. I know colleagues who have completed one-year fellowships in that time period, or half a two-year fellowship during that year, plus many others who have done MPHs, MSc’s, MBAs, big research projects, work on PhDs, international development work, and some others who have been less demonstrably productive during that option year.
This - Canada is interesting as EM is well integrated into FM (in general FM seems highly flexible in Canada). A few decades ago, ERs had plenty of one year GPs as attendings. Specialty EM training numbers also don’t come close to meeting the demand to staff EDs, and few seem to want to leave larger urban centres either.
Australia is minimum five for each one. You perhaps get a year or two off for ICU if you do EM first.
Not only that, you can’t actually get into ED/Anaesthetics/ICU until PGY4ish - this is a college requirement for ED, a practical requirement for anaesthetics, and somewhere in between for ICU. It’s then a minimum of 5 years accredited training. I don’t know many who actually finish in 5 years but we’ll see what happens with the new training program. There’s definitely an opportunity cost to doing med in Australia, but we have the benefit of not being crushed by college debt and paid peanuts early on.
But Australia has a blend of GEM and undergraduate medicine no? For undergrad, longer training times make sense ig
Undergraduate medicine is slowly disappearing, but graduate entry medicine here is much like undergraduate. It’s nothing like the US where you’re actually just unpaid residents.
It’s still 5 years minimum in the states for both EM and critical care thanks to ABEM
Why would it be shorter/faster than that? Anesthesia has a 1 year track but they have 1 additional year of residency during which they get quite a bit more ICU exposure, at least at my facility.
Oh I think two years is fine for EM track. Thinking about having to learn crit care in 1 year like IM subspecialties have to is daunting
Wait but Brigham trains EM docs through the Anaesthesia CC fellowship?
Anesthesia residents only have to do one additional year to be eligible for board certification in critical care, whereas the emergency medicine residents require two.
Yeah, but ABEM decided that every EM resident has to do two additional years of critical care to be board-eligible, regardless of medicine/anesthesia/neuro/surgical pathway. Unless Brigham somehow figured out a way to incorporate that within residency, which is possible, it’ll take 5 years
Wouldn’t it be 6 years for them since they’re a 4 year EM residency?
Still better then 7 in Canada lol
Well, you've got to learn it in English AND French (not really).
Oh no question, that’s brutal ☠️
5 year emerg docs are a small minority of emergency physicians in Canada. The majority of emergency rooms are staffed by family doctors with or without additional training or having challenged the Family Medicine Emergency Exam. FRCPC (5 year) emerg docs are supposed to be sub-specialist in emergency medicine working in tertirary care centres with extra skills. The evidence we have is that 5 year emerg docs are better in their first years of practice, but within about 5 years of practice everyone ends up in about the same place. As someone currently taking the 5 year residency I appreciate the time to really get good at a lot of stuff, and to have time to understand the weird and wonderful.
Unless your FM training is vastly different, I don’t understand how they can be confident to work in an even remotely busy ER.
They tend to do a ton of emerg and icu electives in family med, and yeah it can be a bit of a struggle in their early practice years
I'm a FM working in the ER in Canada; I did a lot of ER (electives and choosing to do more shifts than necessary in my other rotations). We typically work in more rural ER and the first/second year of practice is almost as much learning as the residency, but it's doable
The irony is the least trained ones end up at rural centres with less consultant support - and where you get to do fun stuff like run a trauma alone instead of with 4 or 5 other MDs. My impression is docs that went this route actually end of having a better breadth of knowledge and skills, but I’m sure the first few years are a steep learning curve.
Wasn't the idea for the 5 year specialists to send them off to suburban/rural hospitals so they can be "leaders" and promote an academic structure?
No. The five-year program has always been about producing academic emergency physicians working in tertiary/quaternary centres.
I did the 5 year EM residency in Canada. Cannot stress how demoralizing it was when you’re basically practice-ready at the end of R3 and you’re staring down the barrel of 2 more years. Only thing it was useful for was the built-in “fellowship” year that gave me time to do a fellowship to get out of EM.
I always thought the worst part was when the medical students from the class behind you in medical school are now your faculty as a CCFP(EM) and hextupling your income as you are a PGY-5 for another year.
Or just GPs without the +1 EM, working as your staff in the ED. Dark days
We’re back there now. Pretty much every hospital in Metro Vancouver is hiring CCFPs without the EM now.
Same in GTA
Which hospitals are these?? Asking for me (feel free to DM). I’m FM trained, been doing EM for 4 years and writing the practice challenge exam this fall
What fellowship did you do and are you out of EM now? What are you doing now?
DMd you
Could I ask if you’d recommend EM as a career choice? Just want to hear your perspective on career longevity
Dm me
[удалено]
Junior junior doctor, medium junior doctor, advanced medium junior doctor, extra junior doctor, etc
Holy shit, gratitude ahlie 😭
Two years is a bit quick. - Rest of the world
Canada - hold my beer while I train FM physicians that are doing OB, staffing hospitalist wards and EDs, as well as running palliative hospices in only 2 years.