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  • Second residency in Emergency Medicine

    Hi everyone,

    I've noticed there are many EM docs on this site, so here we go..
    I'm interested in pursuing a second residency in Emergency Medicine. I completed an Internal Medicine residency in 2017 and I have been working as a hospitalist since then. I'm ABIM board certified. I would like to be a more versatile doc - peds, OB, performing lifesaving procedures, etc. I'm planning to apply this coming September but, unfortunately, I don't have any letters of recommendation from Emergency Medicine physicians. Would my application be considered if I don't have LORs from EM physicians? I'm going to apply to most of the 256 EM residency programs to ensure I match.
    It seems very difficult to set up EM clinical rotations as an attending. My requests to do so have been turned down several times. I had 3 months of EM rotations in residency but that was in 2015-2016. I guess, I could work EM shifts at small rural or VA EDs that the locum recruiters keep emailing me about but those seem to be staffed by non-ABEM boarded docs, so I doubt their LORs would be useful.

    I would appreciate some advice. Thank you!

  • #2
    You should ask for a letter from the White Coat Investor. It would go "I don't know how he is in a code, but his ability to perform a back door roth conversions while using index funds will make him a great asset to your program."

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    • #3
      Critical Care would probably be a much more possible path. I don't even know if you'll get interviews if you don't get any SLOEs. Aren't those required?

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      • #4
        MPMD
        Might be able to chime in.

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        • #5
          I would start by becoming an aggressive hospitalist, beginning tomorrow. One could do a lot. Make friends with critical care, anesthesia, surg, ED, radiology. Give out your cell liberally. Be available. Watch people put needles and tubes in people and offer to help and then start doing it yourself. Learn to use an US probe. And moonlight in those EDs. You may find more satisfaction in your current line of work. It’d be way less work and way cheaper than a second residency.

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          • #6
            There are plenty of ERs that hire non EM docs. If you have the inclination and skill maybe you should try your hand there. See if you like it first.

            It would be a good way to test that grass is greener feeling.

            Also maybe you just have a crappy hospitalist job. There are some pretty sweet ones out there that make me think twice about my career choices.

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            • #7
              Move to some rural area and staff their ER. Go to courses/read books. YouTube procedures. School of hard knocks. Don’t feel bad as you’ll still be 100x more competent than anyone else that would staff that place.

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              • #8
                I applaud/admire your spunk.

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                • #9
                  As a core faculty member in an EM program, it's hard to get your foot in the door for a second residency. There are funding issues (basically the hospital won't get any CMS funding your entire residency because you matched in a 3-year program and where therefore permanently allocated to receive 3 years of funding).

                  Some programs require SLOE's. You should ask the ED docs where you rotated as either a student or your EM rotation during your IM residency to write SLOE's for you.

                  It's very competitive. You can find jobs as an internist in smaller hospitals, but probably not the best idea considering you will be placing chest tubes, central venous lines, and taking care of peds, which you probably had limited training with during residency.

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                  • #10
                    Originally posted by nephron View Post
                    You should ask for a letter from the White Coat Investor. It would go "I don't know how he is in a code, but his ability to perform a back door roth conversions while using index funds will make him a great asset to your program."
                    Lol

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                    • #11
                      Originally posted by G View Post
                      I applaud/admire your spunk.
                      Thank you!

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                      • #12
                        Originally posted by southerndoc View Post
                        As a core faculty member in an EM program, it's hard to get your foot in the door for a second residency. There are funding issues (basically the hospital won't get any CMS funding your entire residency because you matched in a 3-year program and where therefore permanently allocated to receive 3 years of funding).

                        Some programs require SLOE's. You should ask the ED docs where you rotated as either a student or your EM rotation during your IM residency to write SLOE's for you.

                        It's very competitive. You can find jobs as an internist in smaller hospitals, but probably not the best idea considering you will be placing chest tubes, central venous lines, and taking care of peds, which you probably had limited training with during residency.
                        Thank you for your input. I'll reach out to my residency ED attendings I worked with in 2015-2016.

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                        • #13
                          jacoavlu I agree with this.

                          be an aggressive hospitalist. Start doing procedures on your own or watch people do them. Be very available. Start moonlighting one ED. You can also moonlight in the icu as well. First couple of shifts will be tough, but you’ll get the hang of it. You’re competent and likely very smart if you went through an internal medicine residency.

                          I don’t think you need another 3 year residency to do what you want.


                          also, I agree with the CMS funding. All of your funding is used from your first residency. If anything, consider critical care fellowship - you get to do everything you mentioned.

                          good luck.

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                          • #14
                            Thank you for your replies. I've thought about CCM but, ultimately, I'd be happier in EM. I rather work up an undifferentiated patient with some peds, ortho, trauma and OB in the mix than rounding on the same vented patient for 7 days in a row. Scheduling in EM, although not ideal, seems more flexible and conducive to normal life than the 7 on / 7 off in hospital medicine and CCM. It's difficult on you and your family when you are working 84 hour stretches every other week. I think I'd be underprepared after doing the 1 year non-ABEM accredited EM fellowship available to FM and IM docs or the 1 year on the job training offered to non-EM boarded docs by TeamHealth.

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                            • #15
                              Originally posted by WorkforFIRE View Post
                              jacoavlu I agree with this.

                              be an aggressive hospitalist. Start doing procedures on your own or watch people do them. Be very available. Start moonlighting one ED. You can also moonlight in the icu as well. First couple of shifts will be tough, but you’ll get the hang of it. You’re competent and likely very smart if you went through an internal medicine residency.

                              I don’t think you need another 3 year residency to do what you want.


                              also, I agree with the CMS funding. All of your funding is used from your first residency. If anything, consider critical care fellowship - you get to do everything you mentioned.

                              good luck.
                              Thanks!

                              Comment

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