From hands-on and varied field experience to a deepened understanding of prehospital care and transition to hospital to your own response vehicle, reasons abound for EM residents to consider an EMS fellowship.
There is much to consider and prepare for in the last years of emergency medicine residency. Apply to be an emergency department physician? Pursue a subspeciality through a fellowship? Seek some other education or adventure before beginning my career? While it might feel overwhelming, based on your goals and aspirations, there is a right path for you.
If those goals and aspirations are to become a successful prehospital medical director, educator, or researcher, then an Emergency Medical Services (EMS) fellowship is worth your consideration.
First, a brief history of EMS, which from inception has been responsive, collaborative, and innovative. What began during the Civil War as a systematic and organized method of field care and transport to manage widespread trauma evolved into civilian ambulances into volunteer rescue squads into initial methods of CPR and other forms of prehospital care delivery before federal and local funding and regulations formalized the profession throughout the 1960s, '70s, and '80s. In more recent history through to today, EMS is the focus of intense research of prehospital interventions and has become the forefront of emergency medical care.1
While the specialty of emergency medicine was approved by the American Board of Medical Specialties in 1979, EMS was not recognized as a subspeciality of EM until 2010, with ACGME accreditation of EMS fellowship programs starting in 2013.2
Today there are 80 accredited EMS fellowship programs in the United States, and an ACGME accredited fellowship is the only way to become eligible to sit for the ABEM EMS subspecialty certification exam, a credential that speaks to your dedication to the subspecialty and better positions you for more competitive positions.3
An EMS fellowship will prepare you for emergency medicine leadership, whatever direction you hope to take your career. And the Core Content of EMS Medicine describes the knowledge and skills graduates of these accredited programs are expected to have mastered.
Despite increasing numbers of programs, little has been written about the characteristics and offerings of these programs,2 meaning interested residents must conduct their own research to appreciate the commonalities and differences among EMS fellowships.
With all that, if these statements resonate with you as an EM resident, an EMS fellowship can further pave the way on your EM leadership journey.
You seek innovation and want to stay current with trends and advancements in prehospital medicine.
The main objective of an EMS fellowship is to teach fellows how to apply the best practices of emergent and community medicine to the prehospital setting.3 Each program will offer innovation differently. For example, only 64% of current EMS fellowship programs offer prehospital ultrasound,2 something that Hennepin EMS (HEMS), based in Minneapolis, Minnesota, has been offering for years. Fellows with our HEMS Fellowship Program benefit from the inpatient and ambulatory services provided by Hennepin Healthcare’s Level 1 Adult and Pediatric Trauma Center and many advanced centers and specialty clinics.
Hennepin Healthcare has maintained a tradition of excellence in education and patient care for more than 130 years as the state’s first teaching hospital. Today, its education and training programs encompass Graduate Medical Education including 11 residency programs and 15 fellowship programs, Undergraduate Medical Education, Advanced Practice Provider, Nursing, Continuing Medical Education, Emergency and Critical Care, among others, plus the Interdisciplinary Simulation and Education Center and a staffed Medical Library. This type of history, infrastructure and offerings are likely important criteria for your fellowship program consideration.
You’re committed to public health and the role EM plays in the community.
Given its inherent integration with public health, EMS physicians interact with a range of stakeholders, from elected and appointed officials to public and private first responders to public safety and community groups and more. A future as an EMS medical director requires significant time dedicated to furthering the EMS field. It’s not a career path for everyone.4 Important to a HEMS fellowship experience is the fact that EMS today is more than just medical services. It’s public health, policy, community education and beyond. There’s immense value for our fellows developing relationships with the people and agencies that are critical to our work – from police and fire chiefs to politicians and neighborhood leaders. Together, we’re shaping the policies and protocols that our community relies on and benefits from every day.
You want to be the best EM physician you can be.
An EMS fellowship unlocks a deeper understanding of both prehospital care and the transition to hospital care, preparing you for a range of EMS physician or medical director career options after fellowship, be that in an EMS system, with local law enforcement, large event organizations, sporting arenas, international medical groups, and more.5 At HEMS, fellows use their fellowship year to explore areas of greatest interest to them, and most parlay those passions into their careers, whether that’s a focus on critical care research, medic and firefighter education, or leading as an EMS medical director.
You seek variety and excitement in your work.
Within program requisites there is a general focus on one or more aspects of prehospital care including operations, administration and research, and each of those will vary greatly by program. At HEMS, for example, our program combines clinical, administrative, and field experience in urban, suburban and outstate (rural) EMS environments. Fellows take an active, hands-on role with HEMS’ dedicated ambulance service along with regional fire, police, and air transport partnerships. They gain experience in mass gathering and event medicine, urban search and rescue, disaster preparedness, austere field care and tactical EMS. Combined with leadership and teaching opportunities, there is always something new to try and learn. Whichever program you choose, ultimate board certification in EMS allows for more diversified work and may decrease burnout by providing other activities outside of ED shifts.4
You have a lot on your plate as a resident right now, and considering an EMS fellowship is just one factor to weigh. Worth extra consideration in today’s market is the fact that there are more EMS fellowship positions than there are applicants,6 making your candidacy to the program of your choosing more compelling. At the same time, there are more emergency physicians vying for fewer spots. Obtaining the additional competitive credential of an EMS fellowship could mean that the most significant year of your medical education is more impactful than you’d anticipated.
References
- Bucher J, Zaidi H. A Brief History of Emergency Medical Services. EM Resident. 2016;43(1):26-27.
- Flamm A, Burch K, Lubin J, Mencl F. Characteristics of EMS Fellowships in the United States. Prehosp Emerg Care. 2023;27(1):84-89.
- Gupta P, Abramson T. So, You’re Thinking About an EMS Fellowship? ACEP Young Physicians Section Newsletter. Jan. 24, 2020.
- Wohlford L, Maksimenko Y. Emergency Medical Services. In: EMRA Fellowship Guide. 3rd ed. EMRA;2023.
- Gresham HW. Emergency Medicine Services and Your EMIG. EMRA Medical Student Newsletter. 2009. Accessed June 25, 2024.
- Trang B. Emergency medicine is grappling with a surprising problem: The prospect of too many physicians. STAT News. Published October 27, 2023. Accessed June 25, 2024.