EM vs EM/IM

[WhyOhWhy]

Just put this reply to a thread in the combined residency forum and I wanted to also post the questions here for some input from EM people. Thanks!

For any of you who are currently residents in a combined EM/IM program what do you feel is the greatest benefit? (say, over just EM or IM alone, or the benefits of EM only over EM/IM)

I've been interested in Emergency medicine since i started school but i also like more long term care specialties so I'm fairly torn. Do physicians certified in IM/EM have the ability to work a set time period in the ED and then a set time period in an IM subspecialty? Or do most IM/EM docs only practice IM/subspecialties (or vice versa, only EM)

Is there any salary difference between a doctor dual boarded in IM/EM and only EM or only IM?

Given the limited number of combined IM/EM residency programs I think it's safe to say they're fairly competitive. Does being dual boarded give you an advantage at all when applying for subspecialties?

And does anyone know why none of the top tier institutions offer this combined residency? (I guess you would consider UCLA, Illinois, etc. to be good institutions.. but why not the Duke's and Mass gen's and Hopkins?)Seems to me that the docs would be much more prepared.. If i had the option of having an MI and going to an ED to be taken care of by an EM doc or an EM/IM doc who completed a Cardiology subspecialty.. well.. It just makes sense I guess.

And lastly, for any of you who were accepted into the combined programs -- Why did you pick that program in particular and what did you do to "set yourself apart" ?? (research, case reports, rock the boards, etc?)

And for those of you who matched in EM programs.. what was your major deciding factor when ranking the programs?

Thanks!

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[Arcan57]

Regarding EM/IM and subspecialty training, the traditional route has been to do pulm/CCM. Most other medical subspecialties are going to require significant clinic time. And if you are only available every other week or take two weeks off a month to work in the ED, it will be very difficult to build up an outpatient practice.

Because of the difficulty in doing both office-based and emergency medicine, being dual-boarded is not likely to be advantageous in obtaining the more competitive IM subspecialties. You'd have to have a very good story for why you are pursuing subspecialty training, and how you would integrate EM into your practice (or say you don't plan on practicing EM and want to do the subspecialty full-time).

Regarding the MI, I don't think an EM/Cards trained doctor is going to have a measurable impact on outcome. Unless you're an interventionally trained cardiologist, there are no acute therapies for MI that can't be performed by an EM physician. The cardiologist will have a much deeper knowledge base, but that doesn't lead to marked differences in therapeutics for the acute period.