Fellows Corner: EMS Fellowship

This week we will pick the brain of Karl Marzec, MD to learn more about the exciting world of EMS fellowships. Dr. Marzec is a recent alumnus of the LAC+USC EM residency and a current EMS fellow at Denver Health.8-31 Karl

What drew you to an EMS fellowship?
I was first drawn to the EMS Fellowship during my intern year when I had a case that was directly influenced by the paramedic’s attention to detail. I was brought an altered patient who was found in his apartment next to multiple empty bottles of alcohol, but EMS also noted that the patient had an empty bottle of isopropyl alcohol (rubbing alcohol) at his side. My differential included toxic alcohols thanks to the pre-hospital team.

Later, during my EMS elective, I was on a ride-along with a crew and we picked up a male who was found down. He was altered and became combative with the paramedic while we were driving on the freeway. The patient was eventually chemically and physically restrained for the safety of the patient and staff.  This was potentially a very dangerous situation that was handled appropriately by the paramedic. Paramedics have a very difficult job that often jeopardizes their safety. My EMS elective exposed me to the day-to-day challenges that paramedics must overcome.

How many EMS fellowships are there, and is there a board certification?
There are approximately 65 ACGME approved EMS fellowships in the US, and they can be found on the NAEMSP website under the Resource tab. There is a board certification for EMS that began a year ago.

How long is EMS fellowship?
Most Fellowships are 1 year, but there are 2 year programs that offer a masters in public health.

What’s the application process like?
I started my application for fellowship in the fall of 2014 (August/September) by emailing the programs of interest and asking them what was required for a formal application. I applied to four programs total and all four programs required a letter of intent that explained my interest in their program as well as recommendation letters. A few programs had supplemental applications, and one program required 3 letters of recommendation. The other programs only required 2 letters of recommendation.

What is EMS fellowship like?
Most fellowships include ride-along programs where the EMS fellow gains knowledge of the EMS system and eventually functions as the attending on the crew. This includes working the radio, making the dispositions/medical decisions for all patients, and hand-off reports at the hospitals. EMS fellowship also includes special events where the fellow is the doctor in charge of a team of EMTs and paramedics at the first aid tents of concerts and sporting events. Some programs have their fellows answer their base station phone calls from paramedics in the field. Many programs include fellows in their medical protocol development, where the fellow helps medical directors update and expand their medical protocols.  All programs require clinical EM shifts where the fellow works as the attending on shift.

What is pay like?
Compensation during fellowship is often equal to a PGY-5 resident with full benefits.  Moonlighting is also usually available to supplement the fellows income.

What type of career can you have after fellowship?
After EMS fellowship, there is the opportunity to work as the medical director for an agency overseeing protocols and day-to-day operations.  There is opportunity for research and education after fellowship as well. You do not need to work in an academic institution to oversee fire/paramedic agencies as a medical director.

How can interested residents get involved now?
If you are interested in the EMS fellowship, I would encourage you to get involved with your local EMS medical director and ask them if there is opportunity for research or ride-alongs.

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