Combined Programs

Hi, I actually asked a similar question awhile ago and if I remember correctly, this is what I learned:

The idea you have is good in theory, but in reality, if you do IM/EM, you would need to keep up both certifications so that when you're older and afraid of being tired, you could "cut back" to just IM. Are you really going to be up to date with IM knowledge if you've spent the first 20 years of your career doing the EM portion?

As for combined programs, go to to the AAMC Freida webpage, you can do a search for combined programs. I think Maryland might have one and there's one in Delaware as well. (When I was looking, I was only interested in east coast programs, but there are others)

I personally think the combined programs are pretty cool (even though I ultimately decided on doing "just" EM), but are particularly beneficial if you have a specific goal in mind (like getting access to pulm/crit care fellowships from IM, or an academic position in which the dual BC helps you into a niche).

Hope that helps!

 

Keep in mind most people only really work in one of these fields. There isnt a ton of stuff out there where you can really use both. We have 2 of our attendings who are Peds/EM trained and outside of giving lectures they dont do Peds floor work etc. They work in the ED.

 

Plus, there's this whole issue: if you don't think you're going to want to do something when you're older, why go into it?

I am curious about the world of combined programs, if people love EM how many are going to hang up their cleats after 15 years and become an internist?

 

Wow, this guy posted 4 times in 4 years. Maybe they deleted some of his posts or something.
I would rather start EM now than do the extra 2 years, and then go into IM in the future if I wanted to "slow down", which won't happen. I wonder if IM residencies will allow you to skip the intern year....

 

It's also a little easier to scale back on the EM side. Want to take it a little easier, see if your group will accomodate you taking fewer shifts. Really not a huge problem.

With IM you'd have more normal hours but it's hard to say to your group "I only want to work in clinic once a week" and have patients that you can only schedule for Thursdays, and, oh, you don't want any call. Your group is unlikely to like this, especially if you're the new kid in the group leaving EM after 15 years to just start working with them.

 

Bingo.

 

To find programs I would suggest using FREIDA or similar database.

 

Would a combined EM/IM help one to become a better EP?

 

There's been lots of discussion of the merits of combined training in the past. You'll probably learn more if you do a search, since people have already said a lot.

 

The EM/IM = better doc than regular EM doc has been covered. Opinions vary (go figure).

Here is the list of EM/IM combined programs..

http://www.saem.org/saemdnn/Home/Communities/MedicalStudents/ResidencyCatalog/EmergencyMedicineInternalMedicine/tabid/278/Default.aspx

EM/Peds is only at U Arizona, Maryland and Indiana.

 

No. Being a better scholar would help you, not another 2 years of residency. You are what you make of yourself, not what your residency makes you.

 

Hi I am interested in the EM/IM programs also and I was wondering about how competitive they were in relation to a straight ER residency?? I know there are 10 programs with about 21 positions available per year so it makes me think that it would be harder to match.

Also I am an FMG, my grades and board scores are good so I am wondering if there's a good chance. Thanks for any info!!

 

They are more competitive.

 

Im not sure of this. I know thats not the case for Peds/EM.

I have heard the combined are easier to get but I have no proof for this and only anectdotal info.

 

I am pretty sure that they won't let you skip the intern year. According to my schools IM PD, you do not have the sufficient IM training to supervise a team even if you completed your EM residency. I was shocked to hear this.

 

They tend to be more competetive than the least competetive EM programs, but not as competetive as the most competitive EM programs (go figure).

 

http://umem.org/res_emim_index.php

From the UMaryland website. Many grads end up as EM faculty at affiliated hospitals. Some current EM/IM residents are actually considering additional years of critical care training. Dr. Mike Winters most recently secured RRC approval for EM/IM/CC at UMd.

Good luck,

PuSh

 

Why? Would you want an internist straight from IM residency supervising 1st year EM residents?

 

What about the value of an EM/IM residency to those of us who may want to attend in the ED and have a small office practice on the side?

-z

 

Why? When would you have time?
If you're going rural, although it pains me to say this, do FM.

FMcF

 

Not going rural. Just exploring my options. I'm finishing up a post-bac program, so I have plenty of time.

-z

 

Awesome. It always helps to plan 6 years in advance.

 

Five, by my count. What's the harm in looking into things? Until AMCAS 2008 is available, I've got some time on my hands.

-z

 

I think you'll find that 99% of students applying to EM, EM residents, and attendings chose the field exactly b/c they were not interested in having even a "small" office practice.

This isn't to say that it can't be done, just that it isn't a big part of the culture...

 

Makes sense. I didn't think there would be a large number of folks doing this, just trying to see what my options are. I'm more a pure EM guy - the more I think about it, the more I doubt a combined residency would get me where I want to get any more than straight EM.

Thanks for the help,
-z

 

This EM doc I recently spoke with said he used to work 6 shifts/week when he first started, and still had the energy to grab a beer most nights with buddies. In his older age, he works 3 shifts/week, comes home, plops down on the couch and can't move.

The beauty of EM: Shifts! I agree w/ Dakota, if the OP's worried about slowing down in old age, EM's flexible.

 

Actually there was just an article in ( I think) the annals of EM (perhaps it was academic em) that surveyed Ped/EM combined program residents. I can't recall the exact number, but a whopping large percent of them practiced EM only...

 

The whopping majority of combined residents of both EM/Peds and EM/IM end up practicing solely EM as the lifestyle is far more manageable for what most people seem to want. As for me, I matched this year in EM/IM and plan on seeking dual appointment at a university teaching hospital post-residency/fellowship but the impetus for me was to enter critical care and do split time ED/ICU (since both are likely to end up being shift work by the time I graduate as most ICUs are going shift work for 24 hour attending coverage). I'd like to focus on early interventions in critically ill patients, Manny Rivers-style, so the dual training really suits me. For those entering international relief work, the benefit of being able to manage both acute and chronic problems suits their work as well. However, if you don't have a distinct plan on how you hope to use both of your residency trainings, the EM/IM pathway I think is of much less benefit and you are likely to be better off considering one or the other, EM or IM.

 

you knw what though? I wouldn't mind a small office on the side - well, a free clinic on the side, really. I just keep thinking that the homeless, etc without health insurance need their HTN and diabetes, etc, controlled, too. Do you need an IM certification to do this???

 

Any licensed physician can work in a free clinic. Some states will even give you a level of immunity.

 

Would you want to manage a staff, answer phone messages, call in refills, do billing etc? I see the point with the desire to do some charitable stuff, but I also think if we're going to say that primary care training does not qualify one to work in an ED then we should admit that the reverse is also true.

There's just too many questions to answer. Would you do geri? What about women's health? Are you going to be person's "doctor" if badness happens? Are you going to start reading primary care literature?

Not trying to be flippant, just enjoying a little healthy debate with my morning coffee.

 

OK, a big fat NO to all your questions. I think I'll just volunteer in a free clinic once a week or something as Miami_med alluded to. Yuck, I guess I was thinking I'd just use a room in someone else's office. I would help run a free clinic, however. Yes, primary care would be best practiced by primary care specialists, but until everyone gets medicare.... it's better than the ED.