THE MULTIPLE PATHS TO A CAREER IN EMERGENCY MEDICINE

Andrei Karpov, Maurice Agha. UBCMJ 2012 4(1):28-29.
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Having only been established as a separate specialty in Canada in June 1980, Canada is one of the only countries in the world with two routes of Emergency Medicine (EM) training.1 Canadian medical school graduates can pursue either a five-year dedicated EM Residency Program administered by the Royal College of Physicians and Surgeons of Canada (RCPSC), or a one-year EM Certificate Program in addition to the two-year Family Medicine Residency administered by the Canadian College of Family Physicians (CCFP).
In British Columbia, Vancouver General Hospital is currently the only hospital which exclusively hires Fellows of the Royal College of Physicians of Canada (FRCPC) EM graduates, while other urban EM departments are currently staffed by both CCFP-EM and FRCPC-EM graduates. In contrast, many rural emergency departments in British Columbia are staffed by Family Medicine physicians with no formal subspecialty training.2
As the Canadian Association of Emergency Physicians continues to engage with both the CCFP-EM and the FRCPC-EM programs to advance the vision of a unified EM training program in Canada, currently interested medical students are still faced with a difficult decision between the two programs.3 We met with University of British Columbia’s (UBC) FRCPC-EM Residency Program director, Dr. Brian Chung, and the Co-Director of the CCFP-EM Residency Program, Dr. Brian Lahiffe, to explain to us some of the differences between the two programs, and provide our readers interested in Emergency Medicine with some advice in choosing the program that is right for them.
Both program directors agree that neither program is on the whole superior to the other and that both are capable of producing excellent EM physicians and distinguished leaders, educators, and researchers within the field.4,5 According to Dr. Chung, the programs are designed “to fill different niches within Emergency Medicine” and that there are unique advantages and disadvantages to both.4 Dr. Lahiffe states that he personally chose to pursue the CCFP-EM route because of the “flexibility it offers in terms of what you could do long-term.”5 He explains that he enjoys both Family Medicine as well as Emergency Medicine and that he feels EM “is one of these careers where one of the risks is burnout, especially when you get older,” and that “having the ability to stay in medicine and do family practice, or retraining for another designation is a fantastic way to go in terms of giving more career options.”5 And while the majority of CCFP-EM doctors practice EM exclusively, he suggested that for students who are exclusively interested in Emergency Medicine, the FRCPC-EM program might be a better option.5,6
Compared to the twelve-month condensed training of the CCFP-EM program, the FRCPC-EM program begins with a broad based post graduate year (PGY-1), similar to the old-fashioned rotating internship, followed by four years of EM-directed training. Graduates of the FRCPC-EM program are expected to have completed a research project, and are provided with dedicated time to pursue a subspecialty interest in emergency medicine. Additionally, residents are expected to lead small-group classes and be involved with the education of junior residents as well as medical students. According to Dr. Chung, these are some of the built-in requirements of the five-year residency program that “would make graduates be more prepared to assume the role of an emergency medicine specialist,” and perhaps reflect the “initial intent of the Royal College Program [to] create academicians who would then stay and practice in an academic urban centre.”4
In terms of advice to medical students interested in EM as a career, both directors agree that the most important thing is to shadow.4,5 “The best advice is to try and shadow an Emergency Physician” says Dr. Chung, “because it is the best way to get to know what we actually do [and decide] whether you are going to be happy doing it on a day-to-day basis.”4 Dr. Lahiffe echoed this sentiment stating that students should “start doing some shadowing, get to know some EM docs, ask them questions.”5 As for research, Dr. Chung explained that it is not necessary, but would definitely help distinguish an applicant.4 Dr. Lahiffe agreed, stating that “if you have the opportunity and interest to do research you should do it.”5 Ultimately, the most important thing is to “make an informed decision and be happy.”5
REFERENCES
1. Steiner IP. Emergency medicine practice and training in Canada. CMAJ. 2003;168(12):1549-1550.
2. College of Family Physicians of Canada, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Institute for Health Information and Health Canada. 2010 National Physician Survey [homepage on the Internet]. [Updated 2010; cited 2012 March 28]. Available from: www. nationalphysiciansurvey.ca/nps/2010_Survey/2010nps-e.asp
3. Sinclair D, Canadian Association of Emergency Physicians. Montreal Task Force Report – Emergency Medicine Training in Canada [homepage on the Internet]. [Updated: 2010 June; cited 2012 March 28. Available from: http://caep.ca/sites/default/files/caep/files/dual_ college_-_dual_certification__historical_timeline_1997-2010.pdf
4. Chung B. Interviewed by: Agha M. 21 Mar 2012.
5. Lahiffe B. Interviewed by: Agha M. 22 Mar 2012.
6. Chan BT. Do family physicians with emergency medicine certification actually practice family medicine? CMAJ. 2002;167:869-870.