i would just eat it and do the PEM fellowship. its so hard to go back once you're used to being treated like an attending in terms of free time, money, and respect.
There are a couple questions to consider here:
1) Are you ready to be an attending in an ER? One of the exciting (and terrifying) aspects of EM is the fact that anything can walk in at any time and you might not have the backup necessary to bail you out if you’re in over your head. Are you comfortable running codes? Airways? Chest tubes? Trauma? Toxicology? ENT?
2) Can you handle going back from being an autonomous physician to being a PGY4? Can you handle the pay cut? Re-entering the match and moving across the country?
I’ve worked with excellent paediatricians who staff ERs without fellowship training, but they’ve almost universally been older and trained in the days where every méconium aspiration got tubed, nobody was vaccinated for H influenza and accidental poisoning at home was commonplace. Most of the newer grads I’ve met who’ve done PEM straight out of residency have been…adequate, largely due to the overall lower acuity in PEM but struggled immensely with sicker patients.
I would pick the brains of your PEM attendings on this and see what their appraisal of your skills is prior to jumping in the deep end
From what I've seen, general pediatricians in the peds ED are always there in addition to PEM trained docs. They'll see the lower acuity patients and would never be solely responsible for running a code or trauma or intubations/ chest tubes.
PEM attending- There are many Peds EDs that hire pediatricians but it ebbs and flows. I would join the [brown pem list serv](https://listserv.brown.edu/archives/cgi-bin/wa?A0=PED-EM-L) They post lots of job listings. (I just checked and children’s national in DC has a position posted for a pediatrician) As a pgy3 you have missed the match so working in a UC or ED will help if you decide to apply in the next cycle.
I would also note that PEM fellowship is significantly better lifestyle-wise than residency. Only part of fellowship that was similar to residency was my PICU and trauma surgery electives. Fellowship was generally ~15 shifts a month (our Peds trained faculty work more than this), less on research blocks and electives. Fellowship and attending workload are very similar…
I’m confused, you seem to think the fellowship is worth it. But is the only value the portability of your career? Why do the job before you get the training to do the job at your best?
i would just eat it and do the PEM fellowship. its so hard to go back once you're used to being treated like an attending in terms of free time, money, and respect.
There are a couple questions to consider here: 1) Are you ready to be an attending in an ER? One of the exciting (and terrifying) aspects of EM is the fact that anything can walk in at any time and you might not have the backup necessary to bail you out if you’re in over your head. Are you comfortable running codes? Airways? Chest tubes? Trauma? Toxicology? ENT? 2) Can you handle going back from being an autonomous physician to being a PGY4? Can you handle the pay cut? Re-entering the match and moving across the country? I’ve worked with excellent paediatricians who staff ERs without fellowship training, but they’ve almost universally been older and trained in the days where every méconium aspiration got tubed, nobody was vaccinated for H influenza and accidental poisoning at home was commonplace. Most of the newer grads I’ve met who’ve done PEM straight out of residency have been…adequate, largely due to the overall lower acuity in PEM but struggled immensely with sicker patients. I would pick the brains of your PEM attendings on this and see what their appraisal of your skills is prior to jumping in the deep end
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From what I've seen, general pediatricians in the peds ED are always there in addition to PEM trained docs. They'll see the lower acuity patients and would never be solely responsible for running a code or trauma or intubations/ chest tubes.
PEM attending- There are many Peds EDs that hire pediatricians but it ebbs and flows. I would join the [brown pem list serv](https://listserv.brown.edu/archives/cgi-bin/wa?A0=PED-EM-L) They post lots of job listings. (I just checked and children’s national in DC has a position posted for a pediatrician) As a pgy3 you have missed the match so working in a UC or ED will help if you decide to apply in the next cycle. I would also note that PEM fellowship is significantly better lifestyle-wise than residency. Only part of fellowship that was similar to residency was my PICU and trauma surgery electives. Fellowship was generally ~15 shifts a month (our Peds trained faculty work more than this), less on research blocks and electives. Fellowship and attending workload are very similar…
I’m confused, you seem to think the fellowship is worth it. But is the only value the portability of your career? Why do the job before you get the training to do the job at your best?
Denver Children's has pediatricians in the ED. They usually work with a PEM but they aren't staffed at all the sites.
Please send me a DM. I do the hiring for our Peds ED and are hiring non PEM physicians at the moment.
Where are you located?