EM or IM?

[yesno]

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3rd year student here. Please direct me as to cons/pros of EM vs IM/cardiology? I must note that 1 month ago I had absolutely no interest in EM because I thought there was too much chaos. But I have now noticed that they can often delegate many unpleasant things to the other specialties and even to nurses. And they have some neat procedures that they do such as sutures, eye exams, ekg, ultrasound.. I must say that I have not done an IM rotation yet. And I don't know if I should even do an elective EM rotation this year? Or if I am interested in EM, I should do an elective in anesthesia(to learn intubations, lines)?

BTW if I had my choice of residencies I would do DERM or Ophto but those are not an option.

Also a question. What is EM's role in anesthesia? Like when do they do regional blocks and when must they consult anesthesia?

 

[Stellar Clouds]

3rd year student here. Please direct me as to cons/pros of EM vs IM/cardiology? I must note that 1 month ago I had absolutely no interest in EM because I thought there was too much chaos. But I have now noticed that they can often delegate many unpleasant things to the other specialties and even to nurses. And they have some neat procedures that they do such as sutures, eye exams, ekg, ultrasound.. I must say that I have not done an IM rotation yet. And I don't know if I should even do an elective EM rotation this year? Or if I am interested in EM, I should do an elective in anesthesia(to learn intubations, lines)?

BTW if I had my choice of residencies I would do DERM or Ophto but those are not an option.

Also a question. What is EM's role in anesthesia? Like when do they do regional blocks and when must they consult anesthesia?

3 years vs 6-7

Intubations, sedation for procedures, a lines, central lines. Not sure why an ER doc would ever need to do a regional block, but perhaps someone can enlighten me.

 

[Bojack Horseman]

3 years vs 6-7

Intubations, sedation for procedures, a lines, central lines. Not sure why an ER doc would ever need to do a regional block, but perhaps someone can enlighten me.

EM does regional blocks to do reductions without having to sedate

 

[Stellar Clouds]

EM does regional blocks to do reductions without having to sedate

Thanks!

Learn something new everyday...I never did an EM rotation as a med student.

 

[yesno]

EM does regional blocks to do reductions without having to sedate

Hospital I am at ortho residents do reductions/splinting. ER residents did not seem to be interested in that at all. I think it would be awesome to do that reduction+splinting. The patient was medically sedated. But it's really neat when a trauma patient has a broken leg and nothing else. I am not a fan of the more serious trauma.

 

[yesno]

I think I could do 6yrs of residency vs 3 if I really preferred one field over another. But I notice that many of the people in 3yr EM residencies are quite happy and they work twice as many shifts as ER attendings! Keep in mind I haven't done any ER rotations and I am just making general hospital observations from the point of view of a new 3rd yr student.

 

[J ROD]

I would suggest you rotating in everything you are interested in.

That way you have first hand knowledge.

 

[sylvanthus]

This is nuts but there are a couple guys who did EM/IM combined and then a cardio fellowship. So like 8 years.

 

[da8s0859q]

Definitely rotate through as much as you can. I'm EM and thus might be a little biased, but it's got a lot going for it.

They're just fundamentally different. If there's someone with a Cr of 8 and a K of 6.9 with peaked Ts on EKG, do you want to:

1. Drop the K a bit, keep an eye on this person in case you need to code them, and get them admitted while you see the next patient, or;
2. Round on that person for a week and get them hooked up with dialysis.

I liked IM too and have nothing but respect for those guys, but most people prefer one of those over the other. I guess you could go IM and do all outpatient, but it's a different way of thinking. EM sees a lot of primary care type complaints anyway.

 

[Happy3nding]

This is nuts but there are a couple guys who did EM/IM combined and then a cardio fellowship. So like 8 years.

What's the point of doing something like this? To have EM as a backup in case you can't get a IM-fellowship you like?

 

[sylvanthus]

What's the point of doing something like this? To have EM as a backup in case you can't get a IM-fellowship you like?

Not sure why someone would do this, from what I saw out of 110 or so EM/IM graduates, 2 for some reason went on to cardio fellowship. No idea why.

 

[kavorca]

It seems to me that most of the older EM attendings that i have met are pretty miserable people (n=10ish). They love the time off but hate the shifts. I am sure there are many who love their jobs, but it seems to be a lower percentage in EM. The younger guys all seem pretty content and willing to work. It may be that all physicians get a little crusty with age, but the job changes less for EM as a specialty. An ER shift is always an ER shift whether you are 30 or 60. I think other specialties can morph their careers into other beasts as they progress. I really didn't like my ER time as a student or intern so take that bias into account.

 

[sylvanthus]

It seems to me that most of the older EM attendings that i have met are pretty miserable people (n=10ish). They love the time off but hate the shifts. I am sure there are many who love their jobs, but it seems to be a lower percentage in EM. The younger guys all seem pretty content and willing to work. It may be that all physicians get a little crusty with age, but the job changes less for EM as a specialty. An ER shift is always an ER shift whether you are 30 or 60. I think other specialties can morph their careers into other beasts as they progress. I really didn't like my ER time as a student or intern so take that bias into account.

There are a multitude of things you can do with EM. International work, disaster medicine, wilderness medicine, EMS, etc etc etc. It is definitely not just working the same ER shift over and over again, unless the person is just plain lazy and cannot think of anything else to do.

 

[J ROD]

EM and IM are very different to me. One is now and one is more wait and see.

I definitely like EM more.

However, I have met many (30+) EM attendings that were very unhappy to me. They complained constantly about this and that.

On the other hand, I am considering Psy and almost all of them liked their job and seemed happy.

I will not even mention the shiftwork deal. It can be very hard. I am flipping back and forth working as a pharmacist between shifts covering for vacations right now and you can feel the drain after awhile. That in itself is almost a dealbreaker for me.

That late afternoon to early am shift is a killer.....

 

[sylvanthus]

I plan on being the night doc. No switching back and forth between shift times then and it is my natural rhythm anyhow.

 

[punkedoutriffs]

I plan on being the night doc. No switching back and forth between shift times then and it is my natural rhythm anyhow.

+1 would do this too, especially if living in a major metro area where places are open at night. Only negatives might be: occasional switching to day time for business or healthcare appts and social events, having to slip out of bed after banging the gf/wife if she is a day-walker.

 

[Geebeejay]

I plan on being the night doc. No switching back and forth between shift times then and it is my natural rhythm anyhow.

Sounds good now, but many people tire of this after 5-10 years though.

 

[mvenus929]

Hospital I am at ortho residents do reductions/splinting. ER residents did not seem to be interested in that at all. I think it would be awesome to do that reduction+splinting. The patient was medically sedated. But it's really neat when a trauma patient has a broken leg and nothing else. I am not a fan of the more serious trauma.

This is going to depend entirely on where you are. Hospitals that have strong residency programs in medicine, surgery, etc, are not going to have strong EM programs because so much gets shuttled off to the other residents. But other hospitals where the ED is more unopposed get to do a whole lot more. There was a hospital that we rotated at as students without an ortho program (they had gen surg, but no other surgical subspecialties as residents), and the EM docs did all the reductions and casting because they got paid for it.

 

[Kal EI]

There are a multitude of things you can do with EM. International work, disaster medicine, wilderness medicine, EMS, etc etc etc. It is definitely not just working the same ER shift over and over again, unless the person is just plain lazy and cannot think of anything else to do.

But none of those pay well or anything near what an EP earns.

 

[Kal EI]

I plan on being the night doc. No switching back and forth between shift times then and it is my natural rhythm anyhow.

Sounds good now, but many people tire of this after 5-10 years though.

Yeah, the switching back and forth is the killer. I think being all nights is the only way to truly avoid it. Some people get less nights but I would enter EM without expecting to switch back and forth.

sylvanthus did you do IM/EM or was that a different poster? If so, how/why would you do IM training to only work at nights?

 

[deuist]

There are a multitude of things you can do with EM. International work, disaster medicine, wilderness medicine, EMS, etc etc etc. It is definitely not just working the same ER shift over and over again, unless the person is just plain lazy and cannot think of anything else to do.

Lazy?!? What the hell are you talking about? None of those other fields you mentioned pay anywhere near working a shift in the ED. In fact, you might lose money doing those things. Try telling your wife and kids that you can't afford things because you didn't want to seem lazy.

 

[sylvanthus]

Lazy?!? What the hell are you talking about? None of those other fields you mentioned pay anywhere near working a shift in the ED. In fact, you might lose money doing those things. Try telling your wife and kids that you can't afford things because you didn't want to seem lazy.

My post was in relation to someone saying ER docs just work the same shift work in the ED all the time. Unbunch the panties.

 

[sylvanthus]

Yeah, the switching back and forth is the killer. I think being all nights is the only way to truly avoid it. Some people get less nights but I would enter EM without expecting to switch back and forth.

sylvanthus did you do IM/EM or was that a different poster? If so, how/why would you do IM training to only work at nights?

Ya im em/im but plan on CC and EM. Floors is horrible.

 

[happygilmore]

.

 

[Kahreek]

if you really liked EM, i cant see you liking the rounds, ohh god the wards, omg the endless wards.

 

[Brigade4Radiant]

In EM you can now to a Pain fellowship so there is something you can do when you get older that makes good money.

 

[J ROD]

In EM you can now to a Pain fellowship so there is something you can do when you get older that makes good money.

Where is this written so I can read it. thanks.

 

[Kal EI]

Where is this written so I can read it. thanks.

I think pain is usually anesthesia, rehab, neuro, psych. Anyway, there are lots of IM fellowships nonetheless.

 

[J ROD]

I think pain is usually anesthesia, rehab, neuro, psych. Anyway, there are lots of IM fellowships nonetheless.

Yeah, I plan on Psy with EM outside track. Also, thinking about Pain.

I did some of it as a pharm. Never heard of EM to Pain.

 

[deuist]

There is a whole thread dedicated to EM --> pain

 

[Kal EI]

There is a whole thread dedicated to EM --> pain

lol, what? Drug seekers?

 

[Kaustikos]

3rd year student here. Please direct me as to cons/pros of EM vs IM/cardiology? I must note that 1 month ago I had absolutely no interest in EM because I thought there was too much chaos. But I have now noticed that they can often delegate many unpleasant things to the other specialties and even to nurses. And they have some neat procedures that they do such as sutures, eye exams, ekg, ultrasound.. I must say that I have not done an IM rotation yet. And I don't know if I should even do an elective EM rotation this year? Or if I am interested in EM, I should do an elective in anesthesia(to learn intubations, lines)?

BTW if I had my choice of residencies I would do DERM or Ophto but those are not an option.

Also a question. What is EM's role in anesthesia? Like when do they do regional blocks and when must they consult anesthesia?

First - at the bolded.

I'd wait and see how things pan out. Saying you think something is interesting is different than actually being a part of it. I never gave hospitalist a thought but I was able to do that with my FM preceptor and I enjoyed it. Made me like IM more, too. It's the experiences you get. There's also the fact that you might end up with a **** preceptor that makes you HATE a rotation/specialty. I'm currently in Peds inpatient and my team makes me have a distaste for it. It sucks because I'm sure a different team would've made a difference. But all I can think of atm is how much I want to leave this rotation.

 

[sylvanthus]

Where is this written so I can read it. thanks.

I know you can do it, but can't find a source. I read it in one of the major publications through AAEM or ACEP. Take a look around, it is definitely possible.

 

[deuist]

http://forums.studentdoctor.net/showthread.php?p=14344036

 

[J ROD]

http://forums.studentdoctor.net/showthread.php?p=14344036

thanks