Combined Residencies?

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7starmantis

7starmantis

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What do you guys think about combined residency programs? Are they worth it or just a waste of time? Anyone interested in applying to one? Its a little early to start thinking about it, but just curious.

Anyone ever heard of a EM/Rad combined residency?
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I've never heard of an EM/Radiology residency... they don't seem very similar to me. Most of the time combined residencies involve two specialties that contain some overlaps, right? Like neurology/psychiatry and peds/medical genetics. You should check out the combined residency forum.
 
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7starmantis said:
What do you guys think about combined residency programs? Are they worth it or just a waste of time? Anyone interested in applying to one? Its a little early to start thinking about it, but just curious.

Anyone ever heard of a EM/Rad combined residency?
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If you want honest answers, you might want to rephrase your questions so that they are not as antagonistic and hostile.

"Are they worth it or just a waste of time" - there are currently thousands of residents in combined residency, including myself. I hope it's not "just a waste of time"

"Anyone interested in applying to one?" - are you seriously asking premeds in a premed forum if they are applying to a combined specialty? FYI, in the 2008-2009 NRMP match data, there were 585 applicants for Med-Peds, 17 for EM/FM, 52 for IM/Derm, 87 for IM/EM, 79 for IM/Psych, 54 for Ped/Psych/Child Psych, etc. So there certainly is interest in combined residencies, each with their own reasons.

And no, there is no EM/Rad combined residency
 
TexasPhysician said:
There is a purpose for combined programs, but few graduates actually practice in both fields. Usually the graduate ends up practicing primarily in the field that makes the most money. Sad but true.
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Roughly half of Med-Peds graduates go into primary care practice, and of this group, between 77-93% provide care for both adults and children.

About 18-25% of Med-Peds graduates go into fellowship training, and of those who do fellowships, at least 50% of them take care of both adults and kids.

Source: Freed et al. Internal medicine-pediatrics physicians: their care of children versus care of adults. Academic Medicine. 2005;80:858-64
 
group_theory said:
Roughly half of Med-Peds graduates go into primary care practice, and of this group, between 77-93% provide care for both adults and children.

About 18-25% of Med-Peds graduates go into fellowship training, and of those who do fellowships, at least 50% of them take care of both adults and kids.

Source: Freed et al. Internal medicine-pediatrics physicians: their care of children versus care of adults. Academic Medicine. 2005;80:858-64
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General IM/Peds don't have significantly different salaries either, and they would be easier to combine than others. Do you have stats on the others?

Most EM/FM would do EM because of the huge bump in pay. Psych/Fam usually practice psych. Child/psych/child psych practice child psych. Granted I don't have stats on this. I was considering a couple of these combined programs. My student affairs director put me in contact with multiple people at different programs. All told me that they wanted students that would combine the two/three fields, but realistically they all mentioned that this rarely happens in real life. People follow money. We do have loans to pay, so it makes sense.

I'm not saying you can't or shouldn't practice both. I'm saying that many combined programs end up not fulfilling their purpose because of reimbursement issues.
 
TexasPhysician said:
General IM/Peds don't have significantly different salaries either, and they would be easier to combine than others. Do you have stats on the others?

Most EM/FM would do EM because of the huge bump in pay. Psych/Fam usually practice psych. Child/psych/child psych practice child psych. Granted I don't have stats on this. I was considering a couple of these combined programs. My student affairs director put me in contact with multiple people at different programs. All told me that they wanted students that would combine the two/three fields, but realistically they all mentioned that this rarely happens in real life. People follow money. We do have loans to pay, so it makes sense.

I'm not saying you can't or shouldn't practice both. I'm saying that many combined programs end up not fulfilling their purpose because of reimbursement issues.
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why don't you provide data to back up your assertion. I do believe that money and salary are great motivators, but you are making assertions and conclusions that are not supported by facts. At least provide a reference, or some data (like I did above to refute one of your assertion). Remember, you are the one making the claim, so the onus is on you to back up your statement
 
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Lol, Dr. M told me they were considered separate, but I guess you are right.
 
schrizto said:
it's true that they're separate because you have to apply again to get a fellowship.
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His exact words were "I have two specialties, so I get paid more." Then he laughed, maybe it was a joke?
 
Shinobiz11 said:
His exact words were "I have two specialties, so I get paid more." Then he laughed, maybe it was a joke?
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He probaby is not up on the terminology. He is specialized in two things. IM and Nephro. He just did a residency and then a fellowship.

He is making more because he sub-specialized in the beans!! :laugh:
 
J DUB said:
He probaby is not up on the terminology. He is specialized in two things. IM and Nephro. He just did a residency and then a fellowship.

He is making more because he sub-specialized in the beans!! :laugh:
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Well he is from Iran, so I guess that makes sense.
 
group_theory said:
why don't you provide data to back up your assertion. I do believe that money and salary are great motivators, but you are making assertions and conclusions that are not supported by facts. At least provide a reference, or some data (like I did above to refute one of your assertion). Remember, you are the one making the claim, so the onus is on you to back up your statement
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The dual programs I chose have much smaller numbers of graduates than IM/peds. I'm not aware that any good studies have been done. I'm just using common sense. If you can make $250,000+ on average in EM or $175,000 average in FM, which one would you do as an EM/FM guy? Starting child psych is around $220,000+ vs peds at $160,000. Another easy answer.

It certainly leaves you the choice if you do a dual program. By all means, use them both. It just makes financial sense to choose EM over FM or child psych over peds. See any number of hundreds of M.D. salary surveys for my references.
 
TexasPhysician said:
The dual programs I chose have much smaller numbers of graduates than IM/peds. I'm not aware that any good studies have been done. I'm just using common sense. If you can make $250,000+ on average in EM or $175,000 average in FM, which one would you do as an EM/FM guy? Starting child psych is around $220,000+ vs peds at $160,000. Another easy answer.

It certainly leaves you the choice if you do a dual program. By all means, use them both. It just makes financial sense to choose EM over FM or child psych over peds. See any number of hundreds of M.D. salary surveys for my references.
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Your "references" are for salaries and nothing else. Again, you are making conclusions and assertions without data.

A very recent study of EM-IM trained physicians showed that a majority of graduates (64%) practice both EM and IM.

Kessler et al. Combined residency training in emergency medicine and internal medicine: an update on career outcomes and job satisfaction. Acad Emerg Med. 2009 Sep;16(9):894-9

Again, you made some claims - where are your references?
 
group_theory said:
If you want honest answers, you might want to rephrase your questions so that they are not as antagonistic and hostile.

"Are they worth it or just a waste of time" - there are currently thousands of residents in combined residency, including myself. I hope it's not "just a waste of time"

"Anyone interested in applying to one?" - are you seriously asking premeds in a premed forum if they are applying to a combined specialty? FYI, in the 2008-2009 NRMP match data, there were 585 applicants for Med-Peds, 17 for EM/FM, 52 for IM/Derm, 87 for IM/EM, 79 for IM/Psych, 54 for Ped/Psych/Child Psych, etc. So there certainly is interest in combined residencies, each with their own reasons.

And no, there is no EM/Rad combined residency
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LOL. Ok, ok...chillax. Although I dont know that the responsibility for poster's antagonism and hostility lies in my question. 🙂

Why dont you just enlighten me since you obviously have more knowledge on the matter than I. Why did you decide to go the combined route? While a majority of graduates from say Med/Peds end up treating both adults and children, are they working as a pediatrician or IM? Do you think the benefits of a combined residency are strictly patient care oriented or are there career benefits aside from maybe landing a job over a single residency doctor?

As a terrible PRE-med I'm just looking into the subject matter and am interested in all thoughts and opinions. Damn this place is intense. :scared:

🙂

Oh, and someone should start an EM/Rad program within the next four years!
 
7starmantis said:
Oh, and someone should start an EM/Rad program within the next four years!
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Why? What would be the practice scenario for someone with that kind of training? It sounds unnecessary, IMO.
 
group_theory said:
Your "references" are for salaries and nothing else. Again, you are making conclusions and assertions without data.

A very recent study of EM-IM trained physicians showed that a majority of graduates (64%) practice both EM and IM.

Kessler et al. Combined residency training in emergency medicine and internal medicine: an update on career outcomes and job satisfaction. Acad Emerg Med. 2009 Sep;16(9):894-9

Again, you made some claims - where are your references?
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You might want to read the references you use.....

Checking your own reference: Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Numbers are copied and pasted. Your number 64% are those that believe it practical to practice both EM and IM. Meaning up to 36% of EM/IM graduates agree that it is NOT practical to practice both at all.

http://www.ncbi.nlm.nih.gov/pubmed/19673705

So only approximately 1/3 use both. Of those that use both, I can't tell what percentage of their time is dedicated to each. I doubt it is near 50/50 because of financial reasons...., but I'm only looking at the abstract.

My common sense seems to hold up with your help........don't need my own references......
 
schrizto said:
Why? What would be the practice scenario for someone with that kind of training? It sounds unnecessary, IMO.
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Well necessary is subjective, enter my dream wilderness medicine fellowship. 😀

I dont know they both interest me...thats about the end of my rational. Although financially you become both the treating physician and the radiologist. I see a lot more benefits for the ED I guess than vice versa.
 
I'd want to do a combined Dermatology-Pathology residency. Then when I'm done I automatically qualify as a dermatopathologist. I'd also only have to do an extra one-year fellowship to become a forensic pathologist, which I have a very good impression of due to a recent autopsy I saw.
 
TexasPhysician said:
You might want to read the references you use.....

Checking your own reference: Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Numbers are copied and pasted. Your number 64% are those that believe it practical to practice both EM and IM. Meaning up to 36% of EM/IM graduates agree that it is NOT practical to practice both at all.

http://www.ncbi.nlm.nih.gov/pubmed/19673705

So only approximately 1/3 use both. Of those that use both, I can't tell what percentage of their time is dedicated to each. I doubt it is near 50/50 because of financial reasons...., but I'm only looking at the abstract.

My common sense seems to hold up with your help........don't need my own references......
Click to expand...

Indeed I was too quick in reading my references (that's what I get for reading journals and posting on SDN after a long day on the wards). At the same time, I guess we have to agree to disagree, since I still maintain that your original assertion that "few graduates actually practice in both fields" is incorrect since in two articles I've shown that that there is a decent amount (37% in EM-IM, roughly half in IM-PD). I don't want this to turn into what exactly the definition of "few graduates" mean since it's obvious we both have different view points on it.

Money is a great motivator, but it's not the only motivator. If that were the case, why would you have people do EM-IM, or EM-FP if they can do straight EM, save 1-2 years, and make the same amount of money? There's something else that makes people want to do combined. In the EM-IM study, it showed that a greater percentage of graduates who do both end up in academic careers (which leads to lower salary) compare to those who just do EM. The same can be said of Med-Peds - IM definately pays more than peds - yet you have people doing both (and the pay can be significant - the more percentage of peds you do, the lower your salary becomes). Yet people find satisfaction in taking care of the pediatric population (in addition to the adults). For me, not only do I enjoy both population, but I enjoy the change. Going from MICU to NICU or PICU, from COPD exacerbation, hyponatremia from SIADH/small cell lung cancer to RSV/Flu/viral meningitis in a 4 month old, etc. For me, it gets boring doing the same thing over and over again, and no amount of money can compensate for the variety and options that I have (including being eligible for fellowships in both the pediatrics and medicine side)
 
7starmantis said:
Why dont you just enlighten me since you obviously have more knowledge on the matter than I. Why did you decide to go the combined route? While a majority of graduates from say Med/Peds end up treating both adults and children, are they working as a pediatrician or IM? Do you think the benefits of a combined residency are strictly patient care oriented or are there career benefits aside from maybe landing a job over a single residency doctor?
Click to expand...

This is a great site that you might want to explore - it will answer some of your questions

http://www.medpeds.org/
 
group_theory said:
This is a great site that you might want to explore - it will answer some of your questions

http://www.medpeds.org/
Click to expand...
While not actually a combined residency, I've never really understood the critical care fellowship for anesthesiology. For some reason, I keep thinking that this would prepare the anesthesiologist to care for patients in the ICU (and not just while in surgery). I know thats not right though....that would be more like Anesthesiology/IM which I don't believe exists (would totally rock though 😀).
 
Well on the subject of combined residencies that don't exist.

EM/General Surgery + Fellowship Trauma/Critical Care would be lovely. Streamline the entire trauma resuscitation-surgery-critical care into one one provider. Maybe even make it EM/General Surgery/Pathology so if they die, they can do the autopsy right in the E.R.

🙂
 
HA! That would be killer. killer, hehe.....


Trauma surgeons run some ERs though right? Or is it just portrayed that way on TLC?
 
EMS5 said:
Maybe even make it EM/General Surgery/Pathology so if they die, they can do the autopsy right in the E.R.
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I know this is said in humor but autopsies aren't done on everyone, it's usually for people who die and the cause of death is unknown.

Some surgeons (like Mohs surgeons) already do the (surgical) pathology part themselves apparently.
 
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Hoody said:
While not actually a combined residency, I've never really understood the critical care fellowship for anesthesiology. For some reason, I keep thinking that this would prepare the anesthesiologist to care for patients in the ICU (and not just while in surgery). I know thats not right though....that would be more like Anesthesiology/IM which I don't believe exists (would totally rock though 😀).
Click to expand...

Actually this is exactly right. IM has no monopoly on ICU care, and generally speaking a critical care anesthesiologist is going to be working in a Surgical ICU.
 
I'd like to give this thread a bump.


Star, I too am interested in dual residency programs. Actually, the idea of combined FM/ED makes sense to me. At least in the ED, there is a lot of crossover--non-immediately life-threatening stuff that comes through the doors. But it also serves to help those that practice FM in more rural areas that are more removed from major medical and trauma centers. What's more, it is interesting and important to keep exposed--keep your hand in the other specialty to keep you sharp and more current.


What bites is that I think there are only two programs that offer limited seats for EM/FM. It also bites that the combined res. is five years long.

I don't want to argue about this, but I think a combined res. of 4 years, though intense, could work if done right--especially if there is an agreement to stay current in both specialities say for five years or so after completing the program.

A lot of ED folks work 12's. I've done this as a RN for a while. You can see and do a lot in 12 hour shifts--and there are more than a few times you end up staying past the 12 hours. It's a Murphy's Law kind of thing that you can't totally ever get away from IMO.
 
EMS5 said:
Well on the subject of combined residencies that don't exist.

EM/General Surgery + Fellowship Trauma/Critical Care would be lovely. Streamline the entire trauma resuscitation-surgery-critical care into one one provider. Maybe even make it EM/General Surgery/Pathology so if they die, they can do the autopsy right in the E.R.

🙂
Click to expand...

General Surgery + CCM = Trauma Surgery.
EM is more medicine than surgery... and if you already know CCM why would you need EM unless you wanna treat pregnancies and allergic reactions?
 
Hoody said:
HA! That would be killer. killer, hehe.....


Trauma surgeons run some ERs though right? Or is it just portrayed that way on TLC?
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Dr. Kill runs the trauma room of Sharp Memorial ER. GS+CCM.

I believe all General Surgeons can be Trauma Surgeons. There's no specialty called "trauma surgery" but that's how the military does it.

There's a difference between the ED and the Trauma/Resuscitation Room.
 
7starmantis said:
Well necessary is subjective, enter my dream wilderness medicine fellowship. 😀

I dont know they both interest me...thats about the end of my rational. Although financially you become both the treating physician and the radiologist. I see a lot more benefits for the ED I guess than vice versa.
Click to expand...

The whole point of specialization is that nobody can do all things as well as multiple people who can focus on just one thing. Radiology, for example, is a 4 year residency after internship, usually followed by a fellowship, for the simple reason that it takes that long, doing nothing else but that, to get any good at it. Even in radiology folks subspecialize now. Sure there are orthopods and surgeons and EM docs who pretend to read their own films, but it's sort of like a banker who plays baseball in his spare time -- he may be very good compared to other bankers, but he's not going pro any time soon. The person who reads a film without spending residency/fellowship doing nothing but that role is simply going to miss the subtleties. Same is true for any non-overlapping specialty (eg pathology mentioned above). Specialization exists because it simply makes sense in a world of fast growing knowledge. Nobody can know it all, keep up with all the changes, and to try to do another whole field on top of your primary field usually means you run the risk of being inferior to someone who does nothing but that. And there is liability attached to not being as good as the standard of care of another specialty. If you read your own films, and miss something a radiologist would typically catch, you are sunk. Meaning financially ruined -- so no the financial benefits of trying to be both the ED doc and radiologist don't exist as the risk is far too high. Sure it seems cool to watch House and see the same team acting as IM, surgery, radiology, pathology, etc., but that's not how real life works.

You could always do both residencies in total, and that might give you a leg up, but the costs outweigh the benefits for most, and it still generally makes sense to pass off the responsibility and liability to someone who spends more time at a field and so is less likely to miss the subtle stuff. Now things like IM/EM, Peds/EM, Peds/IM, etc have a natural overlap and don't force folks to be working outside of their knowledge base, so those combined residencies make sense. But EM rads simply doesn't have the kind of overlap that makes sense.
 
Finding combined residency programs:

Step 1. Go to FREIDA.

Step 2. Click "Residency Fellowship Training Program Search" (menu on the left).

Step 3. Click "Choose Specialty."

Step 4. Select the "Combined Specialty" tab, and viola. You can see all 20 combined specialties within the AMA database.

The strangest one is IM/Nuclear medicine.
 
Personally, I'm premed and have been interested in learning more about some of the Aerospace Medicine residencies. Several of them are combined (I think with IM) or you can do a normal residency and then do a fellowship in AM. At least that is what I have figured out so far.
 
jl lin said:
I'd like to give this thread a bump.


Star, I too am interested in dual residency programs. Actually, the idea of combined FM/ED makes sense to me. At least in the ED, there is a lot of crossover--non-immediately life-threatening stuff that comes through the doors. But it also serves to help those that practice FM in more rural areas that are more removed from major medical and trauma centers. What's more, it is interesting and important to keep exposed--keep your hand in the other specialty to keep you sharp and more current.


What bites is that I think there are only two programs that offer limited seats for EM/FM. It also bites that the combined res. is five years long.
Click to expand...

The EM medical association is pushing to have all Emergency centers staffed by only EM boarded people. Still there are not enough EM people to do this. FM people pick up this slack and work in emergency centers even on a full-time basis. Those that I have seen are very effective and qualified to do so.

The arguement that I see against FM/EM is that there is TOO much overlap to be useful. Could it be 4 years? - Sure, I would agree. The skills are too similar, and as a FM resident you will spend months in the ER and months rotating in other fields just like an EM resident.

A good FM residency will have you well trained in emergency situations to be effective in a rural setting.
 
The other thing financially about em/rads is that you'd spend far less time reading images which is far more lucrative than em patient encounters.

Regarding rads, I'm curious to see in the future if more programs start to go in a more interventional vs diagnostic direction.
 
drizzt3117 said:
The other thing financially about em/rads is that you'd spend far less time reading images which is far more lucrative than em patient encounters.

Regarding rads, I'm curious to see in the future if more programs start to go in a more interventional vs diagnostic direction.
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Interventional is the future of medicine in my opinion. Of course, this doesn't mean you can eliminate all the diagnostic radiologists.
 
drizzt3117 said:
...

Regarding rads, I'm curious to see in the future if more programs start to go in a more interventional vs diagnostic direction.
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It's happening. There have been many many speeches at rads meetings the last two years stating outright that the future of surgery is through radiology, and many programs bolstering their IR departments.
 
TexasPhysician said:
The EM medical association is pushing to have all Emergency centers staffed by only EM boarded people. Still there are not enough EM people to do this. FM people pick up this slack and work in emergency centers even on a full-time basis. Those that I have seen are very effective and qualified to do so.

The arguement that I see against FM/EM is that there is TOO much overlap to be useful. Could it be 4 years? - Sure, I would agree. The skills are too similar, and as a FM resident you will spend months in the ER and months rotating in other fields just like an EM resident.

A good FM residency will have you well trained in emergency situations to be effective in a rural setting.
Click to expand...


Thanks for your response.

I'm wondering then about EM physicians that decide later they want to go into FM. Must they do the full three years residency in FM?
 
Law2Doc said:
It's happening. There have been many many speeches at rads meetings the last two years stating outright that the future of surgery is through radiology, and many programs bolstering their IR departments.
Click to expand...

Yeah, I think some of the plenary talks at asnr and rsna will be quite interesting this year.
 
jl lin said:
Thanks for your response.

I'm wondering then about EM physicians that decide later they want to go into FM. Must they do the full three years residency in FM?
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There is a company in TX that has set-up acute care centers everywhere. It is basically like a family practice, but stays open until 10pm and staffs doctors on shifts like an ER. They do not take urgent patients....just like an urban family practice. This company hires FM, IM, and EM docs to staff it. It is very popular among "burnt out" EM people, because they keep their shift schedule that they love.

I haven't seen an EM doc start a family practice clinic, but I don't see why its not possible. Most EM people would hate the M-F lifestyle with call and responsibilities of running a clinic.....all with making less money. This is why so many of them join non-urgent clinics like I described above.
 
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