EM/IM combined programs? + EM question

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alreadylernd

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I'm a third year med student and I'm interested in EM. Basically, my one biggest concern is that while the flexibility/varied schedule now seems great (I'll graduate from med school at 25), 20-30 years from now, the stress of each shift AND the varied schedule (everyone talks about re-adjusting the circadian rhythms) will be difficult. The solution I was thinking was to do one of the EM/IM programs, and in the future, work in EM but if/when that got too difficult, go back to a clinic setting with IM. Is this feasible?

Also, what are people's opinions about the combined residencies? I talked to an EM doc and he said it was a waste of time, but that was probably because he was so gung-ho about EM and I didn't want to tell him that I'm a little undecided and it was a "fall back" plan.

What do the combined programs allow you to do after residency? Is it also possible to spend half the time in the ED and half the time seeing patients in a primary care setting - I kind of like both aspects!

Thanks! Any comments or opinions would be greatly appreciated since I don't know very much yet!


-JL
 
We happen to have a well establsihed EM/IM program at Christiana Care, and though the majority of these docs are still young, only about 10 years out now from the initial grads, most focused on one practice enviroment, generally EM. However several do perform IM duties such as clinic coverage, hospitalist floor medicine, or have gone on to IM Fellowships, and seem very happy with the flexibility that such a program offers.

One of our EM/IM faculty covers med clinic teaching as well. One of our grads just returned after finsihsing a Pulmonary/CC fellowship and is working exlusively in IM/CC. Finally my most recent EM US Fellow was an EM/IM and is now at UTMB Galviston with appointments in EM, IM and Radiology!

Paul
 
I'm concerned about wanting to specialize in something that you said that you won't use for 20 years. The field will change so much by then that a residency in IM might be outdated. Your idea of splitting time between the ED and the clinic might work, but I've heard that most people with EM/IM certification will pick one field and stick to it.
 
I would say at least 2/3 of the EM/IM grads that I know do both in some capacity and are very happy. I did a CC fellowship after my EM/IM residency and love doing both EM and CCM in the Units. You can't fall back on something you haven't practiced in 20 years, so you really need to keep up when you get out.

kg
 
My 2 cents.....
EM/IM should not be a fall back plan. It is 5 years (a long time) and it is a competitive residency. If you have an interest in academic EM, Critical care or like doing both, go for it. If you aren't sure, sit down and think about it for a long time before applying.

In my case, I was more worried about having a stronger base in internal medicine for EM when I first was interested in it. As I have gone through EM/IM, my interest has moved away from EM and I am planning on an Pulm/CCM fellowship. I still would like to do some EM, but I enjoy CCM best. It has the best of IM and EM. The Pulmonary is to learn to bronch (and bill for it), improve my market value and have some area that isn't (24-7) high stress.
Others in our program have gone on to CCM fellowships, a cardiology fellowship, and we have a few budding interests in cards, CCM and international fellowships still in the program.
EM/IM opens doors. I had no problem getting interviews in strong places. Some even suprised me. Good luck on your decision.
 
Thank you to all who posted, I definitely appreciate the input! I guess i wasn't saying that I would totally ignore IM and then come back to it 20 years later (or at least, that is not what I meant), and I realize that the combined programs are even more competitive than the competitive EM so "fallback" wasn't exactly the right phrase (more like one of a few plans I've been mulling over). My biggest dilemma is that there are definitely aspects of both EM and IM that really appeal to me so I would want to find a way to incorporate both...
 
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