Hey guys - can anyone who has done this and is now currently in practice comment on the usefulness of this training in retrospect? I'm an MSIII and have loved a lot of stuff about IM but really like the acute care setting and love the ER environment. I've also thought about the EM-CCM fellowship. Any thoughts on that?
There are some good threads over in the critical care forum but I'll fill you in on what I learned.
I'm a fourth year going into EM. I was torn between EM, IM, and EM/IM for awhile. I sat down and talked with EM, IM/CCM, and EM/IM/CCM faculty at my school about it.
It used to be that the only route to critical care board certification after completing an EM residency was to also have done IM. Now, EM grads can take the IM critical care boards (just the 2 year fellowship, the 3 year is combined pulm/ccm).
Doing critical care isn't the only reason people do the combined program, but certainly is one of the more popular options. Some of the other EM/IM trained attendings at my school help run our super fancy ED observation unit, for instance. Others go on to do any of the other IM subspecialties. You're also well positioned for academics, research, and leadership positions at a hospital with your unique perspective and very broad training.
I don't have the link just now, but the results of surveys sent to EM/IM grads tend to say two things: 1) they're very satisfied with the training they got and glad they did it and 2) most end up only doing EM but would like more opportunity to use their IM training.
The reason so many end up in EM may be due the fact that you're pretty tied to academics with EM/IM. Getting a job as a hospitalist/intensivist and EP at the same community hospital would be quite tricky as they're almost guaranteed to be staffed by different groups. This very much complicates things like salary and benefits. In academics, the departments just work things out based on how much clinical time you devote to each. One of the attendings I know splits his time 75% ED/25% MICU. The other consideration is that EM just pays more than straight IM hospitalist. Critical care may or may not pay any more than EM.
The most important piece of advice I personally got was to only do EM/IM if I had a clear reason and specific future goal to achieve with that training. Don't do it if you can't make up your mind. Combined programs aren't for everyone. Remember it's 5 years to do both instead of just 3 (or maybe 4 depending on what EM program you choose). It's not as flexible as other combined residencies, like med/peds, where you can see both in a single outpatient practice (and be done in 4 years).
I decided that what I actually liked about critical care and internal medicine were the sick patients and the interesting things to work up, but I got bored to tears as soon as the diagnosis was established or they were stable. In EM I get to decide that in fact your chief complaint of "cough" is in fact a COPD exacerbation or PNA while the internist is stuck watching them for a few days while they get antibiotics or steroids or whatever. In EM I get to start the resuscitation on a septic patient and put lines in. Once they're in the ICU it's just time to manage antibiotics and get them off the vent. All the fun is done!
