Fellowship Opportunities in Military Emergency Medicine
Fellowship Opportunities in Military Emergency Medicine
There are numerous opportunities to complete a fellowship as an active-duty military emergency medicine physician, although policies and specific offerings vary greatly by service. We reached out to Army, Air Force, and Navy EM physicians and leaders to get some information about the application process, current offerings and a more in depth look at what the more popular fellowships entail in terms of curriculum, payback and future job opportunities. We’ll cover a general overview of fellowship by branch first, and then go into some individual specialties. If you’re interested in pursuing a fellowship, best practice is likely to reach out to your individual branch consultant/specialty manager for the most up-to-date information.
There are certain fellowships that are only offered through military programs, including the Point-of-Care Ultrasound Fellowship and EMS and Disaster Medicine Fellowship. These programs allow for concurrent payback of your current military service obligation but incur a one year of service to one year of training additional service obligation with a minimum of two years payback after completion. Other fellowships, such as Toxicology and Pediatric Emergency Medicine must be completed at a civilian program. During this time your current military service obligation is paused and you still incur an additional one to one year additional service obligation.
Applying to the civilian sector can bring its own challenges given that the application timelines for many fellowships do not line up with the military application process. Although these fellowship spots are military funded, making them appealing to some programs, acceptance is dependent on the military releasing you to train. Military fellowship applications are typically due in August with match results announced in December.
In general, the Army is broadly supportive of its physicians pursuing fellowships with routine offerings in a variety of specialties and opportunities to pursue fellowships outside those routinely offered. COL Hartstein (the current EM consultant) had the following general advice for those interested in post-residency training:
“Start thinking ahead to fellowships. Army EM offers fellowships in Peds, Tox, EMS, US as well as Critical Care and the standard non-EM only ones like Army Baylor MHA/MBA, Academic Med. Dedicated spots change year to year based on needs of the Army and are projected in the official school year plan and communicated to the Army EM community through the EM Consultant. However, if you have an interest in a fellowship, or an advanced learning opportunity, you should pursue it even if it is not on the official school year plan–and email the consultant to let her know. All EM Fellowships are open to receive applications even if dedicated spots are not officially open which means if projected fellowships don’t fill to capacity and you have submitted an application the EM Consultant may be able to shift resources to offer you a spot.”
The Air Force is also generally supportive of its physicians pursuing fellowship training. Lt Col Rod Fontenette, Associate Program Director at UC Davis and current president elect of GSACEP was able to give some additional information on Air Force fellowship opportunities. “We send a few folks to fellowship each year from the Air Force side. The most popular fellowships are: Critical Care, EMS, Ultrasound, and Tox. These are pretty much guaranteed every year. We also offer Hyperbarics and occasionally Sports Med, but this one was removed about two years ago. We offered Global Health last year as well. The EMS and Ultrasound [fellows] generally go to San Antonio and train at SAMMC because we have military programs there, but the critical care [fellows] have to go out into the civilian sector to train.”
Fellowship training in the Navy is much harder to come by. CDR Sean Stuart elaborates: “Due to the need for EM physicians to provide EM care to operational focus, fellowship opportunities are limited. If you are going to apply for a fellowship, you need to fully understand and be able to make the case for how that training will directly enhance the Navy mission and fill a critical gap.”
Non-boarded fellowships are possible but very unlikely outside of the ultrasound faculty development program at Portsmouth that takes one staff each year. Other boarded fellowships such as pediatrics, toxicology, critical care and EMS are not routinely offered but may open as current staff leave. The precept is the best source for potential fellowship openings with a preview coming out in June and final version in October. Specific questions should be addressed to the Navy Specialty leaders.
Pediatric Emergency Medicine Fellowship
Dr. Paul Schunk (Army)
The Pediatric Emergency Medicine Fellowship (PEM) is a 2 year civilian fellowship. The number of spots for Active-duty doctors changes from year to year depending on Army projections. The PEM fellowship will teach you how to better care for critically ill and medically complex children. You will also become a subject matter expert in pediatric emergency medicine. Post-fellowship many will pursue careers in Academics. During the fellowship most of your time will be spent in the Pediatric Emergency Room. Depending on the program you choose there will be rotations in PICU, NICU, Anesthesia, Child Abuse, Ultrasound, and others.
When you are looking at programs ask if they take Emergency medicine residents into their programs, as some programs will only take pediatric trained applicants or take pediatric applicants preferably. Overall the PEM Fellowship was a great educational and professional development experience! This fellowship is two years long and results in an additional two-year service obligation.
Dr. Carl Skinner and Dr. Kevin Maskell (Army)
The medical toxicology fellowship provides fellows with the knowledge and experience needed to successfully manage poisoned patients. Substances addressed in the fellowship range from pharmaceuticals to industrial chemicals and from street drugs to naturally occurring venoms and toxins. Each program across the country has its own areas of special emphasis, but will generally provide opportunities for a broad range of inpatient consults, outpatient toxicology clinic, and poison center-based experiences.
Most toxicology fellowships also have a strong academic and research focus, making them an excellent launching point for a career in academic emergency medicine. A few have the opportunity to earn a Master of Public Health. There is currently no dedicated military toxicology fellowship program. All trainees will complete their fellowships at an accredited civilian program of their choosing. This fellowship is two years long and results in an additional two-year service obligation.
Critical Care Fellowship
Dr. Scott Sullivan (Army)
Critical care fellowships afford EM physicians the opportunity to become trained and work clinically in the ICU environment. EM physicians benefit from a variety of critical care pathways that are available, and are eligible to train in anesthesia, medical, surgical, neurocritical care, and resuscitation programs. These programs can vary in length, typically 1 or 2-year offerings, and vary in curriculum depending on the focus of the program, which may or may not afford a pathway to board certification. Some programs may also require EM applicants to have performed a prerequisite number of rotations during residency in ICUs or medical/surgical wards before being allowed to directly supervise residents in non-EM ACGME programs. Although these prerequisites generally do not prevent acceptance to a critical care fellowship, these rotations must be completed prior to starting the core curriculum and come at the expense of elective time in fellowship, which may hinder those looking to focus electives to acquire special skills or experiences.
EM-critical care (EM-CC) physicians have career opportunities that span the breadth and depth of the emergency medicine and critical care communities. Some graduates split time between EM and ICU practice, others prefer to spend all of their clinical time in one environment or another. Additionally, given the broad range of critical care training programs available, EM-CC physicians may work in MICUs, SICUs, mixed units, or even specialty units such as cardiovascular/surgical, ECMO, transplant, burns, etc. Active-duty career opportunities likely will vary based upon the service and the duty location. Many active-duty graduates may be expected to continue working in the EM field, potentially even for a majority of clinical time. Graduates with special skills may only be able to practice those skills in certain duty locations (such as ECMO), so careful consultation with the critical care consultants and personal education about these opportunities are essential elements to success and achieving career goals post-graduation.
Active-duty EM applicants should consult carefully with their respective service EM consultant and critical care consultants to understand which programs are permissible by each service (some may only allow programs with board certification pathways), and match this with the applicant’s area of interest. Military service obligation for this fellowship depends on the length of the program and if the fellowship was completed at a military or civilian program.
Dr. Rachel Ely (Air Force)
The SAUSHEC EMS & Disaster Medicine Fellowship is a tri-service, two-year training program. It is one of the largest EMS fellowships in the nation, accepting up to four fellows annually. During the ACGME-accredited first year, fellows focus on the foundational skills of EMS medical direction encompassing online medical direction, protocol development, continuous quality improvement, initial training and continuing education, and EMS research. This first yearprepares fellows for ABEM board certification as EMS physicians. SAUSHEC fellows also act as an Assistant Medical Director for the San Antonio Fire Department, as well as for several agencies in the surrounding region. In addition to San Antonio’s fire-based system, fellows spend time with other service delivery models such as Austin-Travis County EMS and Acadian Ambulance, with opportunities to get involved in tactical EMS, aeromedical transport, search and rescue, and more. In a typical week, a fellow will spend 24-48 hours of on-line medical direction call, spend 1-2 days per week in the field responding to EMS calls, spend time in didactics both as students and as instructors, work a clinical shift in the emergency department, and complete research projects and MPH coursework.
In the second training year, fellows focus on topics of military significance such as branch specific practices in EMS, patient movement downrange, point of injury casualty care, and the military role in large scale disaster response. Fellows are involved in regional system building via the Southwest Regional Advisory Council (STRAC), and respond to crises with the Emergency Medical Taskforce (EMTF). A military unique curriculum aims to prepare graduates for global conflicts through experiences designed to develop future experts in military prehospital systems with the US Army’s Institute of Surgical Research Joint Trauma System (USAISR JTS), US Army Medical Center of Excellence (MEDCoE) Combat Paramedic program, US Air Force’s Critical Care Air Transport program, US Army’s Strategic Trauma and Readiness Course (STARC) and with JBSA Fire and Emergency Services. The disaster medicine focus of the second year is complemented by the MPH curriculum, a two-year program which is completed virtually through the University of South Florida and specifically emphasizes Global Disaster Management, Humanitarian Relief, and Homeland Security. Recently, the fellowship was reviewed by the American Board of Physician Specialties (ABPS) and graduates are qualified to sit for the ABPS Disaster Medicine Qualifying Examination.
Graduates of the program have gone on to various roles, including medical direction for installation EMS, trauma system development with partner nations, en route care research with the Institute of Surgical Research, battalion and brigade surgeon, branch EMS medical director, 160th Special Operations Aviation Regimen (SOAR), JSOC Joint Medical Augmentation Unit (JMAU) and more. This fellowship is two years long and results in an additional two-year service obligation.
Dr. John Knight (Army)
The Point of Care Ultrasound (POCUS) fellowship is a one-year fellowship designed to be an advanced education program for clinicians interested in becoming experts and leaders in the growing subspecialty of non-invasive extensions of focused diagnostic exams. Its use continues to extend the capabilities of emergency and critical care physicians to improve diagnostic accuracy at the bedside, safely guide invasive procedures, rapidly detect life threatening pathology, avoid unnecessary ionizing radiation for the patient, monitor the effects of an ongoing resuscitation, and improve ED and ICU throughput.
POCUS Fellows are responsible for advanced personal education as well as the education of residents within the Emergency Medicine Residency. There are four primary components: sonologist training/procedural competency, teaching, research/scholarly activity, and administration. The fellowships meet the ACEP Emergency Ultrasound Fellowship Guidelines and fellows are expected to learn and ultimately teach ultrasound modalities such as advanced trauma evaluation, critical care, advanced cardiac, ovarian, musculoskeletal, nerve blocks, bowel and advanced pulmonary.
While the bulk of the applicants are Emergency Medicine Physicians, the military programs do extend opportunities to other specialties including Family Medicine, Internal Medicine, and Physicians Assistants. This fellowship is one year long and results in an additional one-year service obligation.