EM/IM Combined Residency Applicatoins... Advice please

[waterski232002]

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Does anyone know when applications are due for the combined programs? I originally applied to a bunch of straight EM programs, but am now considering applying to a few EM/IM combined programs. My entire application is geared around applying to straight EM programs (all my LOR, dean's letter, and personal statement revolve around my passion for EM and say nothing about IM). Will I need to write a new personal statement and/or have a new dean's letter and LOR put together? Also, what are they're requirements for LOR's? I have 2 EM letters and 1 letter from the chair of cardiology...

Any advice to others who are going through the process or have already been through the process would be greatly appreciated....

 

[waterski232002]

I meant, "any advice FROM anyone who is going through or has been through the process would be greatly appreciated"

Thanks

 

[mikegoal]

well i am applying for EM/IM.

The first question is are u applying just as a "backdoor" to EM or are you really intrested in it. I think it is probably a good idea to express that in the personal statement. I am applying to straight EM as backup and my personal statement is the same with 2 sentences extra about em/im.

As far as LOR i have 2 from EM and 2 from IM. 2 from EM and 1 from Im should be fine(I think)


http://forums.studentdoctor.net/showthread.php?t=153632

 

[waterski232002]

well i am applying for EM/IM.

The first question is are u applying just as a "backdoor" to EM or are you really intrested in it. I think it is probably a good idea to express that in the personal statement. I am applying to straight EM as backup and my personal statement is the same with 2 sentences extra about em/im.

As far as LOR i have 2 from EM and 2 from IM. 2 from EM and 1 from Im should be fine(I think)


http://forums.studentdoctor.net/showthread.php?t=153632

I'm about 80% sure I'll end up doing a straight EM residency, but I want to do a fellowship in critical care and work at an academic center/teach. The only way to be legitimately board certified in CCM is to also have BC in IM, so if I was going to go to a 4 year program, I mind as well just make it 5 and be double boarded. Plus, the extra knowledge would be useful in both EM and in CCM. I think I'll just tack on a couple extra sentances to my PS and then submit it to the combined programs.

Aren't the combined IM/EM positions a lot less competitive???? My numbers are pretty good so hopefully it will be enough to get me an interview.

 

[mikegoal]

There are a lot less people applying but also very few spots(just over 20 in the country). i am not quite sure how competative it is

 

[jashanley]

They are as competitive as straight EM. Sorry to say. Fewer spots, strong applicants who are truly interested in EM/IM, make it a competitive residency choice. They are competitive not due to sheer numbers, but due to programs focusing on applicants truly interested in EM/IM. The small numbers and 5yr program length, make it important to find future residents truly interested in EMIM and who will fit into the program itself and make it stronger each year.
I wish you all good luck. I can say that programs look for people who give a strong argument for why they want to do EM/IM, not just a few sentences tacked on the end of the statement.

 

[MS05']

I'm about 80% sure I'll end up doing a straight EM residency, but I want to do a fellowship in critical care and work at an academic center/teach. The only way to be legitimately board certified in CCM is to also have BC in IM, so if I was going to go to a 4 year program, I mind as well just make it 5 and be double boarded. Plus, the extra knowledge would be useful in both EM and in CCM. I think I'll just tack on a couple extra sentances to my PS and then submit it to the combined programs.

Aren't the combined IM/EM positions a lot less competitive???? My numbers are pretty good so hopefully it will be enough to get me an interview.

Hey Waterski....To my limited understanding, I don't think you NEED the bc in IM to do CC. There are several CC fellowship places, Pittsburgh immediately comes to mind, that take EM trained bc people. If CC is your endpoint career, you may be able to get there 2 years soon by doing straight EM. I'm by no means the authoritative voice in the matter, but look into CC programs that take straight EM people if you're interested....

 

[waterski232002]

Hey Waterski....To my limited understanding, I don't think you NEED the bc in IM to do CC. There are several CC fellowship places, Pittsburgh immediately comes to mind, that take EM trained bc people. If CC is your endpoint career, you may be able to get there 2 years soon by doing straight EM. I'm by no means the authoritative voice in the matter, but look into CC programs that take straight EM people if you're interested....

You are right that many CC programs will accept pure EM residents; however, once you have finished the fellowship you can never be board certified in CCM if you are not boarded in Internal Medicine first.

There is a loop-hole.... If you are EM and you finish a 2-Year CCM fellowship, you can apply to sit for the European CCM boards (in europe you do not need to be BC in Int Med to sit for CCM boards). The United States has reciprocity with the European CCM boarding academy, so technically if you are "european" boarded in CCM your board certification will be recognized in the United States. Who knows if this will change--the Europeans could close their doors to american EM physicians jumping through this loop hole at any time.

 

[PimplePopperMD]

Ultimately, the decision to pursue both specialties ought to be determined by one's interest, not by "competitiveness" or lack thereof.

There are many options on finishing, and I believe that as there are more graduates, there will be increasingly more career pathways. Thus far, grads have done many things, including CC, only IM, only EM, split IM/EM, subspecialty IM, fellowship in EM...

If you do want to pursue both specialties, you can bet that it will be a question asked at every interview, and if your answer is not well-thought-out, your numbers/letters/background all don't matter... it's really that simple. Because it turns out that the hospital actually loses on us -- the medicare system will pay for the first three years of our training, but the final two years are picked up by the hospital...(this is my understanding)... thus, the institution is investing in us, and that is why there are so few programs. This is also why our interest in pursuing both specialties is so paramount in the application. Residency is hard. Two residencies are harder... and a five year committment is a long, long time!

Having said that, I believe that I am being very well trained for both specialties, and each specialty supplements my training for the other.

 

[waterski232002]

Ultimately, the decision to pursue both specialties ought to be determined by one's interest, not by "competitiveness" or lack thereof.

There are many options on finishing, and I believe that as there are more graduates, there will be increasingly more career pathways. Thus far, grads have done many things, including CC, only IM, only EM, split IM/EM, subspecialty IM, fellowship in EM...

If you do want to pursue both specialties, you can bet that it will be a question asked at every interview, and if your answer is not well-thought-out, your numbers/letters/background all don't matter... it's really that simple. Because it turns out that the hospital actually loses on us -- the medicare system will pay for the first three years of our training, but the final two years are picked up by the hospital...(this is my understanding)... thus, the institution is investing in us, and that is why there are so few programs. This is also why our interest in pursuing both specialties is so paramount in the application. Residency is hard. Two residencies are harder... and a five year committment is a long, long time!

Having said that, I believe that I am being very well trained for both specialties, and each specialty supplements my training for the other.

It's not a question of competitiveness for me at all. I know that I will get a good residency in straight EM, so it's not like I would be applying to EM/IM as a "back-up". I am interested in IM b/c I feel that it would make me a better EM physician, better prepare me for academics (which I am interested in), and better prepare me for a fellowship in critical care as well as allow me to become certified in the field. The competitiveness issue only came up b/c it's late in the application process. I do not have LOR that indicate my interest in IM, my deans letter is submitted and does not indicate my interest in IM, and my CV is entirely geared towards EM. This late in the process, it would be difficult to change those things on my application (some are impossible). Thus, I was hoping that I would still get interviews at combined programs if I applied with the application I have right now, and hope that I could express my interest in the combined programs when/if I got an interview. Is a straight EM application with good numbers enough to get interviews or should I just forget about it?

 

[KGUNNER1]

You are right that many CC programs will accept pure EM residents; however, once you have finished the fellowship you can never be board certified in CCM if you are not boarded in Internal Medicine first.

There is a loop-hole.... If you are EM and you finish a 2-Year CCM fellowship, you can apply to sit for the European CCM boards (in europe you do not need to be BC in Int Med to sit for CCM boards). The United States has reciprocity with the European CCM boarding academy, so technically if you are "european" boarded in CCM your board certification will be recognized in the United States. Who knows if this will change--the Europeans could close their doors to american EM physicians jumping through this loop hole at any time.

Just a clarification. There is no such thing as reciprocity between Europe and the U.S. in regards to critical care boards. The fact remains you don't need to be board certified in critical care to practice critical care. The number 1 speciality that bills critical care time in general internal medicine, followed by pulmonary and then family practice.

If you are interested in both, you don't NEED to do a combined EM/IM residency. Several of my friends are unit directors or in very desirable academic positions in great institutions.

If you have more questions about this, please check out our FAQ section on the ACEP website. http://www.acep.org/1,4252,0.html

I would also encourage any interested candidate to join EMRA's critical care interest group and/or ACEP's Critical care section.

Good luck,
KG

 

[waterski232002]

I actually got that information from the critical care link on the ACEP website. http://www.acep.org/1,5411,0.html

Maybe you can clarify what they are talking about for me. I would really like to practice CCM in an academic center and I guess I feel that many programs may not consider me if I am not "board certified". I assume when you are appplying for a job after fellowship, all hospitals will ask for your CV and if you are board certified/board eligible? I realize that you don't need to be board certified in order to practice CCM, kind of like how you don't need to be board certified in EM to practice in an ED (but it would be much more difficult to get an academic position without EM residency training/certification). Am I just making all this up??.. or is there some truth to this. Are straght EM/CCM physicians competitive at getting faculty positions in critical care at academic centers without having any board certification??? Does anyone actually take the European exam???

Thanks for your help...

Just a clarification. There is no such thing as reciprocity between Europe and the U.S. in regards to critical care boards. The fact remains you don't need to be board certified in critical care to practice critical care. The number 1 speciality that bills critical care time in general internal medicine, followed by pulmonary and then family practice.

If you are interested in both, you don't NEED to do a combined EM/IM residency. Several of my friends are unit directors or in very desirable academic positions in great institutions.

If you have more questions about this, please check out our FAQ section on the ACEP website. http://www.acep.org/1,4252,0.html

I would also encourage any interested candidate to join EMRA's critical care interest group and/or ACEP's Critical care section.

Good luck,
KG

 

[KGUNNER1]

I actually got that information from the critical care link on the ACEP website. http://www.acep.org/1,5411,0.html

Maybe you can clarify what they are talking about for me. I would really like to practice CCM in an academic center and I guess I feel that many programs may not consider me if I am not "board certified". I assume when you are appplying for a job after fellowship, all hospitals will ask for your CV and if you are board certified/board eligible? I realize that you don't need to be board certified in order to practice CCM, kind of like how you don't need to be board certified in EM to practice in an ED (but it would be much more difficult to get an academic position without EM residency training/certification). Am I just making all this up??.. or is there some truth to this. Are straght EM/CCM physicians competitive at getting faculty positions in critical care at academic centers without having any board certification??? Does anyone actually take the European exam???

Thanks for your help...

The post on our ACEP website said that ESICM has a "reciprocal relationship" with SCCM. This basically means that we are "brothers" in the delivery of critical care and a big pond won't separate us. Many SCCM consensus statements are jointly accepted by ESICM and vice versa. SCCM is just another speciality organization, like ACEP. It has nothing to do with boards. The organizational body that oversees boarding is the ABMS (American Board of Medical Specialties. Representatives from each respective specialty sits on this.

Critical Care "boards" or "certificate of added qualification" (CAQ) are approved by ABMS and then each respective speciality oversees the exam. So if your primary speciality is IM, then the ABIM gives you your "board" shingle in Critical Care after you pass the requirments. ABS for surgery, ABP for Peds and ABA for Anesthesiology.

ER made a "deal with the devil" many years ago when we became our own speciality that no EM grad would try to do added training in other specialities. That is antiquated and we are trying to change this.

Many people have taken the EDIC or European boards. When you apply for a job, you can specifically state that the reason you aren't "boarded" in the US is because there is NO board in the US. But you've done the next best thing and taken the European board. This has not been much of an issue at all in the past. Once you round, and show that you know what you are doing, the docs don't care what your base is.

David Huang is faculty at the Univ. of Pitt (along with Scott Gunn and David Crippen). They have all 3 taken the European boards. David is straight EM/CCM. He can give you a little better perspective than me, since I'm EM/IM/CCM. Just drop him an email, [email protected]. He doesn't mind. As a matter of fact, none of us do, that's why we want to be EM/CCM mentors to med students and residents like yourself.

Good luck,
Kyle