Deciding between EM vs IM, please help!!

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BigBear123

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Hi guys,

I'm trying to decide whether to apply EM or IM for residency. I am torn. I want to go back to the west coast (I'm currently at a well ranked east coast school) but my clinical grades - all high passes - may keep me from doing so, at least for EM. If I end up choosing IM, I think I will do rheum. I know this is not a competitive or super sexy field for most people, but I think I could be pretty happy in it. However, I love the excitement of EM and it's hard for me to say goodbye to the possibility of pursuing this field. I was just wondering if you guys had any input or have been in this position? Thank you all! And of course I included my pro-con list for your amusement because that's what I do.

IM:
Pros -
- can probably get into west coast program
- fellowship will be a lot better than residency
- i like IM people
- can work M-F 9-5 as an attending
- i don't need an exit plan, can work in this field until old age
Cons -
- residency is super hard and time-intensive
- less pay, but this isn't a huge issue for me because i am lucky enough to not have med school debt
- not as exciting as EM and fewer procedures

EM:
Pros -
- don't work a ton of hours
- when you're off, you're off
- i will have time for outside interests as an attending
- residency is somewhat easier
- i like the pace better, and i like getting first dibs at diagnosis
- my personality is ADHD in some respects and i like getting to switch from one thing to another and not having to be SUPER thorough like in IM
- more opportunity for procedures
- pay is better
Cons -
- it sucks working nights/evening/weekends
- no guarantee that i'll get into a west coast program
- i don't get along as well with EM people - i don't get the "one of us" feeling
- i will burn out working the awkward hours (i'm not saying all EM docs do, but knowing myself well enough i think i will)
- i'm not a fan of traumas - i know i won't have to work in a trauma center as an attending, but will definitely have to during residency
 
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What do you mean by first dibs at diagnosis? Anywho, I'd go with IM to Rheumatology, since you really won't do well in EM because you don't like working nights/evenings/weekends, you don't get along as well with EM people, you know you'll burn out, and not a fan of traumas.
 
I get the "First Dibs at diagnosis" i.e. you constantly see undifferentiated patients and set them on the right course. It's an awesome responsibility, we'd like to think us guys on the floor are able to correct a bad diagnosis from the ED, but often times an incorrect or too early diagnoses that are made in the ED can act as blinders and set patient care on the wrong track for a day or two.

Trauma should be something you at least see yourself not dreading. I did a rotation at a rural ED (that was actually the smaller of two EDs in the county), even they still had car accidents. Also: hunting accidents. You should have no problem seeing yourself running a trauma code, stabilizing a spine and doing RSI. I've seen ED attendings waffle and waver during RSI. It is suboptimal.

I have an ADHD personality. I cannot handle EM. I lose track of notes and would forget about patients if I didn't have help while I'm down there. If I don't have a regular schedule my distractibility goes through the roof, so shift schedules are even more of an anathema.

While "when you're off, you're off" is nice, there's a lot of ways to achieve that in IM. Also, going to meetings or conferences at 10:30 AM the day after finishing a stretch of nights is more annoying than having to take home call once every week or two (IMHO).

I'm in a specialty where my personality doesn't match the majority of my colleagues. It's not bad, but interviewing for residency/fellowship/jobs can get annoying since I never "just really click" with most doctors. I actually click most with EM residents. However, as I said, they do not want me in their ED except for codes.

EM used to require a standardized group letter of recommendation taken from your ED clerkship. If they still do that, going through the clerkship early and getting feed back on how good of a "fit" might be useful.
 
BigBear123 said:
Hi guys,

- i don't get along as well with EM people - i don't get the "one of us" feeling
- i will burn out working the awkward hours (i'm not saying all EM docs do, but knowing myself well enough i think i will)
Click to expand...

based on the above, it's pretty obvious that EM is a bad choice for you.

more importantly, you haven't explained what you actually like about IM - aside from getting into a west coast program and working 9-5 (which is not accurate).
 
BigBear123 said:
Hi guys,

I'm trying to decide whether to apply EM or IM for residency. I am torn. I want to go back to the west coast (I'm currently at a well ranked east coast school) but my clinical grades - all high passes - may keep me from doing so, at least for EM. If I end up choosing IM, I think I will do rheum. I know this is not a competitive or super sexy field for most people, but I think I could be pretty happy in it. However, I love the excitement of EM and it's hard for me to say goodbye to the possibility of pursuing this field. I was just wondering if you guys had any input or have been in this position? Thank you all! And of course I included my pro-con list for your amusement because that's what I do.

IM:
Pros -
- can probably get into west coast program
- fellowship will be a lot better than residency
- i like IM people
- can work M-F 9-5 as an attending
- i don't need an exit plan, can work in this field until old age
Cons -
- residency is super hard and time-intensive
- less pay, but this isn't a huge issue for me because i am lucky enough to not have med school debt
- not as exciting as EM and fewer procedures

EM:
Pros -
- don't work a ton of hours
- when you're off, you're off
- i will have time for outside interests as an attending
- residency is somewhat easier
- i like the pace better, and i like getting first dibs at diagnosis
- my personality is ADHD in some respects and i like getting to switch from one thing to another and not having to be SUPER thorough like in IM
- more opportunity for procedures
- pay is better
Cons -
- it sucks working nights/evening/weekends
- no guarantee that i'll get into a west coast program
- i don't get along as well with EM people - i don't get the "one of us" feeling
- i will burn out working the awkward hours (i'm not saying all EM docs do, but knowing myself well enough i think i will)
- i'm not a fan of traumas - i know i won't have to work in a trauma center as an attending, but will definitely have to during residency
Click to expand...

Hey BigBear, is EM on the West Coast really that competitive? Would you mind sharing the range of your Step 1 score? Is it above 220?
 
Depends on what he means by the "west coast."

If he means only places like San Diego, Los Angeles, San Francisco, and Seattle, then yeah its pretty darn competitive.

If he's okay with places like Fresno, Bakersfield, Sacramento, Las Vegas, Phoenix, etc.. then its only average in terms of competitiveness.
 
What numbers are you using to say EM is paid more than IM. Are you assuming that you will just stay a general internist because procedural based cardiologists make bank (Just as an example)
 
From what I learned from senior Physicians - burn out is a reality is EM. And there is always the frustration of not being able to followup own patients (As they will be taken over by other specialist) . But there are strong PROs as you mentioned.
 
lovarts said:
From what I learned from senior Physicians - burn out is a reality is EM. And there is always the frustration of not being able to followup own patients (As they will be taken over by other specialist) . But there are strong PROs as you mentioned.
Click to expand...

Open patient chart, see the final diagnosis and treatment plan. Follow-up done.
 
lovarts said:
From what I learned from senior Physicians - burn out is a reality is EM. And there is always the frustration of not being able to followup own patients (As they will be taken over by other specialist) . But there are strong PROs as you mentioned.
Click to expand...

Every EM residency requires patient f/u for discharged and admitted patients. You just go to the patient's chart give them a call if they were discharged. If they were admitted just to through the chart and see their medical course.
 
My step 1 is mid 230s. I guess west coast would not be an option if I did EM.

I looked at the IM resident lists and they have a strong school representation (meaning few or no IMGs, mostly came from well ranked MD schools) even for the community programs - the norcal kaisers, scvmc, cpmc. Do I have a shot at the places with my average/slightly below average grades? I'm at a top 20 school not sure how much that will help me though - i know everyone and their mother wants to be in CA.
 
awared2 said:
I'm pretty sure that's not allowed if you no longer have a role in their care
Click to expand...

It's allowed. They're my patients, and it's important for me to know what happened to them. Sometimes it's important for me to know if they followed up after I sent them home from the ED.
 
TooMuchResearch said:
It's allowed. They're my patients, and it's important for me to know what happened to them. Sometimes it's important for me to know if they followed up after I sent them home from the ED.
Click to expand...
Weird, I've always been told the opposite. If you don't have any hand in their care (such as in EM), you don't have the right to look at their records.
 
You want good money and horrible hours or decent money and decent hours?
 
This is pretty weird, I was going to post almost this exact same thread today. Right down to IM -> Rheum vs. EM (+/- ultrasound), minimal med school debt, ADHD, etc. So, I guess we think alike, OP. Aiming for community/suburban sites on the east coast. 249 s1, with mix of honors/HP (hp in medicine) in 3rd year.

I guess the big difference is that I do tend to click really well with some EM attendings in terms of personality. IM people seem a bit too nerdy/ivory tower to me, but at the same time it would be cool to come up with a baller obscure diagnosis, as rare as that is on the floors. Its also nice to see someone get better over the course of a few days in the inpatient world. Residency in IM does seem like it sucks a fatty though. Four days off a month?

Biggest thing turning me off from EM is the nights. I LOATHE nights. I don't care about working christmas or whatever, but nights just destroy me mentally. That, and a lot of EM attendings at my school are like "fuk EM y dont you do derm?" which is ridiculous but, either way, it is concerning that this is one of the only rotations I've ever been on in med school where the attendings don't try to recruit you.

Gaah. Considering family med out of desperation at this point too, thinking I could get some procedures and maybe have a shot at some rural EM stuff that way, but then you blow your shot at cool fellowships. As I said, rheum seems cool in terms of diagnosis and lifestyle, but allergy, ID could also be neat. **** this ****.

anyway, just trying to keep the conversation going. appreciate any stories/advice people have to throw in
 
BigBear123 said:
My step 1 is mid 230s. I guess west coast would not be an option if I did EM.
Click to expand...

what's this garbage? mid-230s makes you competitive at nearly any EM program including those on the West Coast.

and FWIW, the IM programs in California that are worth a damn (eg not ****hole community programs) are way more competitive than the EM programs. And even then, 230s won't hold you back at most of them.
 
BigBear123 said:
My step 1 is mid 230s. I guess west coast would not be an option if I did EM.

I looked at the IM resident lists and they have a strong school representation (meaning few or no IMGs, mostly came from well ranked MD schools) even for the community programs - the norcal kaisers, scvmc, cpmc. Do I have a shot at the places with my average/slightly below average grades? I'm at a top 20 school not sure how much that will help me though - i know everyone and their mother wants to be in CA.
Click to expand...

230s is fine. Especially with solid clinical grades and coming from a T20 school.

FWIW as others have said highly desirable IM residencies in CA will be just as competitive as their EM counterparts.

1st pick the specialty you prefer then pick the location.
 
BigBear123 said:
Hi guys,

I'm trying to decide whether to apply EM or IM for residency. I am torn. I want to go back to the west coast (I'm currently at a well ranked east coast school) but my clinical grades - all high passes - may keep me from doing so, at least for EM. If I end up choosing IM, I think I will do rheum. I know this is not a competitive or super sexy field for most people, but I think I could be pretty happy in it. However, I love the excitement of EM and it's hard for me to say goodbye to the possibility of pursuing this field. I was just wondering if you guys had any input or have been in this position? Thank you all! And of course I included my pro-con list for your amusement because that's what I do.
Click to expand...

I am struggling with the same decisions. Currently a 3rd year trying to figure it out. Why not consider EM/IM programs?
 
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