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EM/CC vs EM/IM or EM/IM/CC

Discussion in 'Combined Residencies' started by Scrubs87, Nov 13, 2011.

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  1. Scrubs87

    Scrubs87

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    Third year med student interested in the above 3. With EM grads now eligible to take the IM CC boards, can anyone with more experience speak to the advantages of EM/IM or EM/IM/CC? Is there any advantage to the additional IM training in this case?
  2. Hamhock

    Hamhock

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    I am not too much more experienced, but I am currently thinking:

    1. I wish this option/confusion existed when I was a 4th-year med student.

    2. Ideally, for the young doc, the best option is an IM/EM/CCM program with a very strong and inter-disciplinary CCM program.

    I am true believer in the idea of inter-disciplinary CCM. It will take a long time for surgery-CCM to come around (sadly, it will be a monetary decision), but eventually it will be that way...and - in my opinion - that is the kind of training someone should be looking for.

    In other words: It is more important to find an EM/multi-disciplinary CCM program than a vague EM/IM/CCM program.

    HH
  3. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    I have been thinking about this also and am kind of leaning towards EM/CCM and forgoing the IM training. Not sure how smart that is since this track is relatively new. Guess it boils down to, do we really need the additional IM training to be competent in CCM?
  4. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor

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    Only an MS3, but I think EM with a CC fellowship would serve most people fine.

    I would still personally probably opt for the EM/IM/CC route because the IM certification adds a lot of career flexibility and a little more alphabet to your soup for just one extra year of training. Probably particularly beneficial in academics...
  5. Jack is Back

    Jack is Back

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    How does that work? 3 year EM + 1 year IM + 2 year CC fellow?
  6. jdh71

    jdh71 si vis pacem, para bellum

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    I don't think so, but I still think it's helpful.
  7. K31

    K31 EM PGY-1 Gold Donor

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    EM/IM is five years; some of the programs allow you to add a sixth year to become board-eligible in CC.

    From what I've read, for most programs you apply as EM/IM and decide in your 4th year whether you want to do the extra year. If you do, your last two years are mostly ICU time.
  8. jdh71

    jdh71 si vis pacem, para bellum

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    EM/IM is 5 years. A critical care fellowship will be two more.

    As I understand it, the combined EM/IM/CC residencies will be only 6 years.
  9. K31

    K31 EM PGY-1 Gold Donor

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    An extra year of training worth of helpful? (Forget EM/IM + 2yr CC--I've already taken 8 years for med school)
  10. jdh71

    jdh71 si vis pacem, para bellum

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    It's totally not necessary, but I find my chronic disease background to be helpful in the MICU. It all kind of depends on what you want to do in the future.
  11. K31

    K31 EM PGY-1 Gold Donor

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    Likely academics, and probably MICU--came into med school thinking IM followed by pulm/CC. I decided I definitely want an EM component, but really like the complex pathophys management part of IM that is lacking in EM because of the short duration of care.

    I'll be applying next cycle. Right now I'm thinking I'll apply mostly to EM programs with a strong CC component, plus the EM/IM programs that have the option of 1 extra year for CC.
  12. jdh71

    jdh71 si vis pacem, para bellum

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    All of that sounds great.

    Like I said I think it can be helpful, but it's not necessary. You'll be a great critical care doc by the time your done either way.
  13. Jack is Back

    Jack is Back

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    7 years training?

    So you could train neurosurgery or EM/IM/CC...
  14. jdh71

    jdh71 si vis pacem, para bellum

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    Yup. Lol

    Though I think it would make for the most well rounded intensivist.
  15. inspirationmd

    inspirationmd

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    If you think about it, a good chunk of specialties require 5-6 years nowadays (Cards, Pulm-CC, Surgical Specialties, Radiology/Rad Onc, etc). Even Anesthesia/Path training takes 5-6 years now due to the job market since it takes completion of a fellowship to have the most options from what I hear. Neurosurgery takes 6-8 years but your lifestyle is WAY worse in residency than as an EM/IM on average and likely after you get out. You may as well put in the time now to have the most options later on and if you want an EM component to your practice then EM/IM is really the option to go with unless you want to be doing a second residency.

    I will be the first one to admit that being done in 3 years or transitioning to fellow status in 3 years would be nice. EM-IM is only worth it if you can envision a way to use both components of the training. EM/IM/CC is a nice option to facilitate this but I have seen other models where people go on to full Pulm-CC or Cards fellowships and attend in the ED during their fellowships. If you can not then you should apply categorical IM or EM. Honestly my personal opinion is that you should not apply EM/IM if you are not: 1) Interested in academics or 2) very interested in research opportunities in something that is relevant to EM and IM or 3) in love with patho-physiology mechanisms at the intersection of EM and IM. If you don't have a plan for how you are going to use it, its going to burn when you are still an intern when your co-residents are about half-way done with their residency or when they start getting job offers and you have 2 years to go.

    You have to have a plan. EM/IM provides a wide variety of options in a changing health care landscape. EM/CC is a new and exciting option but I think it has some issues right now. The most glaring issue is that IM certification requires 6 months of IM training of which only 3 months can be MICU. Where in the avg 3 year schedule is a resident going to find time for extra Gen Med time? (do subspecialty months count?) Yes, it is possible the fellowship will let you meet this requirement as a fellow but its also possible they may not. Would the EM/CC fellow then be a resident on Gen Med for those months? If you go this route you should either plan to enter a 4 year EM program where you will get the exposure during residency or identify as many fellowships beforehand who would let you meet the requirement during your fellowship by calling them. Great moment for EM with the certification option but as with everything the devil is in the details.
  16. inspirationmd

    inspirationmd

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    Just read that they have to be Gen Med months in Nov 2011 ACEP News article. So sub-specialty months don't count
  17. icaruswalks

    icaruswalks

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    Bump. Just wanted to see how you guys were thinking/doing since this thread has started. MS3, soon to be MS4 here thinking the exact same thing. I like EM/CC/IM, but not sure which way to go, which programs to shoot for, competitiveness, etc. Bumpity bump
  18. jdh71

    jdh71 si vis pacem, para bellum

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    There are very few 6 year combined programs - some places may not even advertise.

    Your best bet is to email those places that do have an established EM/IM program and ask if they also offer the EM/IM/CC pathway.
  19. K31

    K31 EM PGY-1 Gold Donor

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    I've been doing this with the programs in areas of the country where I'd be interested in living, and the answer so far from most of them is "No".
  20. jdh71

    jdh71 si vis pacem, para bellum

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    Well there are very few EM/IM programs in general.

    I'm almost certain you can get the 6 year gig at Hennepin County in Minneapolis (at least some of the EM/IM guys were talking about it).

    The Twin Cities aren't too shabby either.
  21. K31

    K31 EM PGY-1 Gold Donor

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    That's a negative per my communication with their PD. He said they've discussed it but apparently most of their residents want to do the full pulm/CC fellowship. A friend of mine has threatened to call a psych consult on me if I seriously consider EM/IM-->pulm/CC after an 8-year MD/PhD.
  22. jdh71

    jdh71 si vis pacem, para bellum

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    It is beginning to sound more and more like a theoretical possibility but no one is doing it yet. That's unfortunate.
  23. inspirationmd

    inspirationmd

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    http://www.bidmc.org/CentersandDepa...etOurTeam/AcademicFaculty/MichaelDonnino.aspx

    Does happen. Know of a few other folks who have done it. Also guy at Maryland did EM/IM then 2 year CC fellowship at Dartmouth.

    I am curious why people would opt for the an extra 2 years to do Pulm once they have done EM/IM. That's 4 board exams every 10 years. Have to do what you love I guess.

    As far as programs adopting the 6 year pathway I think it probably has to do with most people wanting to just stay in EM after doing EM/IM and not bothering with a fellowship. So if you have only 2-4 fellows a year and only 1 at most wants to do it then it may not be worth it. Historically strong CC programs like Maryland and Henry Ford may opt for it for any and all interested residents though.
  24. jdh71

    jdh71 si vis pacem, para bellum

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    This isn't what we are talking about. What K31 is looking for are the combined EM/IM/CC 6 year programs

    He could do EM/IM and then a 2 year CC fellowship like everyone else, but he's looking to cut the year. It seems finding a program that will do this is difficult.

    On the ABIM website it only lists three programs: Maryland, Henry Ford, and Long Island Jewish
    Last edited: Apr 16, 2012
  25. K31

    K31 EM PGY-1 Gold Donor

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    Yeah, exactly. I want to combine emergency medicine and critical care. I don't need the IM training, but I think it would add to my strength as an intensivist.

    However, I'm not willing to be in training for ever. I'm going to be 30 as it is when I graduate from med school, and I've decided 6 years post-grad training is my limit. Thus I'm applying mainly to EM (especially CC-strong programs, with the plan to do a 2-year fellowship afterward), and also to those EM/IM/CC programs where the 6th year for CC board eligibility is a possibility.
  26. inspirationmd

    inspirationmd

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    Got it. Well I think you have the right idea about your application strategy given your goals. The PhD should definitely kick open most doors with your goals as well.

    Another thing you have to think about is that some of the more critical care based EM programs are 4 year programs (ie. Cincinnati, Northwestern, Denver etc) so you have to ask yourself if a 4 year EM and then 2 year CC fellowship is a consideration as well. Falls within 6 years but some people don't like the 4 year programs but they likely would make getting a top notch CC fellowship easier as well.

    Consider also with EM/IM/CC the downside of Medicine clinic. If you want to be an intensivist dealing with the primary care stuff can suck. Have to ask yourself if overall the IM training would be worth this. Something to consider.

    Just curious, what'd you do your PhD in? Critical care related?
  27. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Anyone thinking about going this route this year?

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