EM resident applying for IM position

[waterski232002]

I am an EM resident and just curious if I were to do an IM residency, how many months of credit (if any) an EM residency grad could get. Does anyone know any EM residents who have gone on to do IM residencies?

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[dmaes]

I am an EM resident and just curious if I were to do an IM residency, how many months of credit (if any) an EM residency grad could get. Does anyone know any EM residents who have gone on to do IM residencies?

Not from personal experience but somewhere here http://www.saem.org/rescat/contents.htm it states that you can receive up to 6 months credit toward a medicine residency but this is at the discretion of the residency director.

 

[threepeas]

I am an EM resident and just curious if I were to do an IM residency, how many months of credit (if any) an EM residency grad could get. Does anyone know any EM residents who have gone on to do IM residencies?

i would be very interested in the details of why you want to switch to IM from EM?
I am considering EM with some other things and would love your perspective.

 

[waterski232002]

i would be very interested in the details of why you want to switch to IM from EM?
I am considering EM with some other things and would love your perspective.

I have no desire to ever practice IM... The only reason I am considering it is to get board certified in Critical Care. Then I would split time in the ICU and in the ED. However, I could do anesthesiology and then get boarded in Critical Care as well. The other option is just to the Critical Care fellowship straight out of EM but then not get board certified... it would just drastically limit my marketability and job options.

 

[inositide]

anesthesia is the fastest way to CCM board certification.

you could apply directly to a pgy-2 anesthesia position (skipping prelim year), and upon completing pgy2,pgy3,pgy4 (ie. ca-2,ca-3,ca-4 anesthesua years), do a 1yr ccm fellowship. you could get boarded in anesthesia and ccm.


also, if you like EM, anesthesia might be more similar to it.

triple boarded in EM+ANES+CCM = $$$$$$$$

 

[threepeas]

I have no desire to ever practice IM... The only reason I am considering it is to get board certified in Critical Care. Then I would split time in the ICU and in the ED. However, I could do anesthesiology and then get boarded in Critical Care as well. The other option is just to the Critical Care fellowship straight out of EM but then not get board certified... it would just drastically limit my marketability and job options.

i am considering the very field tracks that you are as a medstudent. i did ER and CCM as a PA. from all the attendings i have spoken with anesthesiology to CCM is the way to go. 2 weeks in the OR and 2 weeks in the ICU. you would be very popular. just for curiosity sake what is the main thing you are looking for in these fields versus say..general surgery (which is another field on my hit list)? good luck.

i like patient evaluation that comes with EM/IM which is the main reason i wander if i will enjoy anesthesiology. i like the procedures, anatomy, physiology, drugs of anesthesiology, but you dont get to do that investigative H and P.

 

[waterski232002]

Right now I am a first year EM resident, and have always had a desire to do CCM. Doing MICU and PICU this year so far has only solidified it. I like the acuity, the vent management, the sedation, and the pressors/drips. Similarly, I like the idea of short term patient contact (2 wks max in the ICU, and when they leave, they never bother you again).

I like EM because it has a great lifestyle, good pay, and his highly flexible, plus patients will never tie me down, and I can move jobs any time I want (never have a practice to worry about). More importantly, I like the resuscitations/codes in EM, and the fact that we stay very sharp on our diagnostic and emergent therapeutic skills. I know enough about all serious problems to evaluate any type of patient, and I don't need to know the isoteric B.S.

As far as Surgery goes... I HATED the OR with a passion. I have no desire to suture up a colon and break adhesions for 10 hours on end on a saturday night. I like the acuity of surgical patients, but in reality, your patients are not that sick unless you're at an academic center. Residency is a biatch as well.

I am still undecided between whether Anes or IM would be the better route to CCM, or if just doing a straight CCM fellowship after EM would be best. Honestly, it's hard to think about putting in 5 extra years of training (~750,000 in salary loss) just to work in an ICU a little bit. If I can get by with just doing a CCM fellowship after EM, that might be best. Anyone with any advice on this?

 

[waterski232002]

triple boarded in EM+ANES+CCM = $$$$$$$$

CCM would actually be a pay cut compared to either EM or Anesthesia. Unless you know something that I don't. Last time I checked the avg salaries were...


Anes - $275,000
EM - $216,000
CCM - $215,000

Plus EM and Anes work a lot less for the $$$$... so it's not for the money

 

[inositide]

CCM would actually be a pay cut compared to either EM or Anesthesia. Unless you know something that I don't. Last time I checked the avg salaries were...


Anes - $275,000
EM - $216,000
CCM - $215,000

Plus EM and Anes work a lot less for the $$$$... so it's not for the money

I've always wondered why the Anes avg salary is so high. I would love to hear an explanation.

 

[threepeas]

I've always wondered why the Anes avg salary is so high. I would love to hear an explanation.

1. demand
2. high billing level-procedures, etc.
3. reimbursment rates-favorable fee schedules

these 3 items will get anyone a higher than average salary.

 

[waterski232002]

The reimbursment for an intubation in the ER is about $150 whereas suturing a 5 cm lac can reimburse as much as $600. Kinda sad that EM doc's get paid more for their urgent care skills than their live-saving abilities!

I wonder why anesthesia gets a higher reimbursement for their procedures in the OR than EM gets for the same procedures in the ED. Or does anesthesia only get $150 for the actual intubation and the other $$$ are made by other billings.

 

[threepeas]

The reimbursment for an intubation in the ER is about $150 whereas suturing a 5 cm lac can reimburse as much as $600. Kinda sad that EM doc's get paid more for their urgent care skills than their live-saving abilities!

I wonder why anesthesia gets a higher reimbursement for their procedures in the OR than EM gets for the same procedures in the ED. Or does anesthesia only get $150 for the actual intubation and the other $$$ are made by other billings.

maybe the other thing to consider is hours worked. the ER i worked in as a PA EM got $110/hr + bonus + 10%401K contribution. worked out to about $280K a year which was the average in this area (DC/baltimore). the anesthesiologists i knew worked about 55-65 hrs/wk if you include call time at the hospital and made 50-75K/yr more. so per hour it was pretty close.

 

[Gregg]

Waterski,
There are some CCM fellowships that love EM docs. There are several threads on EM about that and the movement to allow EM boarded docs to do CCM fellowships and sit for boards. By the time you finish your residency you may just be eligible to do that. Good luck, 'cuz that's what I'd love to do.

 

[waterski232002]

I know... I've been on most of those threads. But the word on the street is that it will probably be at least 5-10 years before there is any attempt at a EM/CCM fellowship (and some people feel that it will never happen). Definitely not going to happen when I'm done with residency in 2 years.

For now there is a LOT of resistence from the IM world. EM made a deal when it became a nationally recognized specialty, and told the ABIM that we would never compete or be able to subspecialize in any of the IM subspecialties. Now that we are trying to get into CCM, they are using our prior arrangement against us.

What programs have you heard are EM friendly?

 

[lateness]

Right now I am a first year EM resident, and have always had a desire to do CCM. Doing MICU and PICU this year so far has only solidified it. I like the acuity, the vent management, the sedation, and the pressors/drips. Similarly, I like the idea of short term patient contact (2 wks max in the ICU, and when they leave, they never bother you again).

I like EM because it has a great lifestyle, good pay, and his highly flexible, plus patients will never tie me down, and I can move jobs any time I want (never have a practice to worry about). More importantly, I like the resuscitations/codes in EM, and the fact that we stay very sharp on our diagnostic and emergent therapeutic skills. I know enough about all serious problems to evaluate any type of patient, and I don't need to know the isoteric B.S.

As far as Surgery goes... I HATED the OR with a passion. I have no desire to suture up a colon and break adhesions for 10 hours on end on a saturday night. I like the acuity of surgical patients, but in reality, your patients are not that sick unless you're at an academic center. Residency is a biatch as well.

I am still undecided between whether Anes or IM would be the better route to CCM, or if just doing a straight CCM fellowship after EM would be best. Honestly, it's hard to think about putting in 5 extra years of training (~750,000 in salary loss) just to work in an ICU a little bit. If I can get by with just doing a CCM fellowship after EM, that might be best. Anyone with any advice on this?

i have a question, do general Critical Care docs, not EM boarded ones, do they do intubations? b/c when i did ICU i was at it was the anesthesiologist..?

 

[BMW19]

I hear a lot of people that are interested in EM also say that they might be happy in critical care. What similarities and differences exist between the two specialties? I am curious because I am interested in EM but now with all of this talk about Critical Care I thought I should check it out. They seem to always be mentioned together even though one is IM.

Thanks,

BMW-

i have a question, do general Critical Care docs, not EM boarded ones, do they do intubations? b/c when i did ICU i was at it was the anesthesiologist..?

 

[Gregg]

I heard that Maryland was EM friendly for CCM. I can't remember the others. Ford has that IM/EM/CCM triple going on, but it's 6 years. Maybe you could transfer in?