EM vs. IM. Help!!!!

[icaruswalks]

---

Members don't see this ad.

Hello SDN!

In a serious bind here... I need to get my act together for ERAS, etc. but I'm totally stuck between two specialties. EM and IM.

I did an IM sub-I and absolutely loved it! EM brought me to med school... and I'm doing a rotation now and I love it too! What to do? Anybody else in the same bind?

I liked IM for the thinking process, and caring for patients to the end, but I missed doing procedures and felt like I was doing a lot of treating of lab values and vitals from a computer somewhere in the hospital. A lot of tele-medicine.

I like EM for the procedures, the pace, the breadth of practice.

I like residents and faculty in both departments, but find the EM residents to be less anal and more like people I could spend time with. IM is so broad though, that there are still lots of options to specialize, etc.

Help!

 

[armybound]

you can always be an IM-minded EM doc who actually thinks about their patients instead of just paging a consultant /inflammatory trolling

or you could specialize within IM and do more procedures and exciting stuff.

 

[Smokemont]

Hello SDN!

In a serious bind here... I need to get my act together for ERAS, etc. but I'm totally stuck between two specialties. EM and IM.

I did an IM sub-I and absolutely loved it! EM brought me to med school... and I'm doing a rotation now and I love it too! What to do? Anybody else in the same bind?

I liked IM for the thinking process, and caring for patients to the end, but I missed doing procedures and felt like I was doing a lot of treating of lab values and vitals from a computer somewhere in the hospital. A lot of tele-medicine.

I like EM for the procedures, the pace, the breadth of practice.

I like residents and faculty in both departments, but find the EM residents to be less anal and more like people I could spend time with. IM is so broad though, that there are still lots of options to specialize, etc.

Help!

I would go with IM. Your reasons are the same as mine. Great general training and then soooo many options to specialize if you want to do more procedures.

 

[DrSnips]

Or go EM/IM. I know a couple attendings who are EM/IM and actually do practice both.One of them was my attending on my medicine rotation for a week and on my ED rotation for a shift. It was interesting to see him bring some IM reasoning to EM.

 

[group_theory]

Or go EM/IM. I know a couple attendings who are EM/IM and actually do practice both.One of them was my attending on my medicine rotation for a week and on my ED rotation for a shift. It was interesting to see him bring some IM reasoning to EM.

There is the option of doing a combined EM/IM residency - it's 5 year in length but you are board eligible for both ABIM and ABEM (and if you want to do a fellowship in medicine, you are eligible). There are a handful of programs around the country - UCLA, UIC, University of Maryland, VCU, etc

 

[AquaFortis]

There is also the option of doing IM and specializing in critical care. Many of the procedures would overlap and you would certainly have the acuity (and sometimes the pace). The downside would be no peds/OB.

I would also note that depending on where you are in the country, hospitalists certainly perform procedures including central lines/art. lines as well as intubation if you're aggressive in learning those skills.

 

[OveractiveBrain]

Hello SDN!

In a serious bind here... I need to get my act together for ERAS, etc. but I'm totally stuck between two specialties. EM and IM.

I did an IM sub-I and absolutely loved it! EM brought me to med school... and I'm doing a rotation now and I love it too! What to do? Anybody else in the same bind?

I liked IM for the thinking process, and caring for patients to the end, but I missed doing procedures and felt like I was doing a lot of treating of lab values and vitals from a computer somewhere in the hospital. A lot of tele-medicine.

I like EM for the procedures, the pace, the breadth of practice.

I like residents and faculty in both departments, but find the EM residents to be less anal and more like people I could spend time with. IM is so broad though, that there are still lots of options to specialize, etc.

Help!

Its all about the bullshit What can you stand least? If you go into private hospitalist gigs (7on 7 off) you do little more than what the ED does; get them out. Your goal is discharge. Your goal is to see as many patients as possible, only the time frame changes. If you don't mind drunks, minor lacs, psych patients and frequent fliers, to ED. You'll continually THINK you've diagnosed the problem, but since your differential is only 10 things that will kill you, you'll often be wrong. if you don't mind rocks, social work, and "coordinating care" (tracking down consultants, calling nursing homes, and face time with ancillary staff), to IM. You will actually diagnose the problem, THINK you've done good, only to see them fail anyway. Im in IM. The reason i like IM is for the problem solving, the initial differential, the diagnosis. I like the ED screens the crap for me. If its busy, I still might get handed a bad consult, but at least the other 90% has been screened away for me. I also happen to be at a place where the ED is pretty poor, leaving me to decide most of the workup inpatient. Both have tremendous burnout (5 years) for private ED and private hospitalist. The gig is the same. The more patients you see, the more money you make, and keep those patients off your service so that when you come back on shift they aren;t still there. If you were comparing primary care and ED, that's ******ed, and you clearly didn't ask that.

 

[KinasePro]

Both have tremendous burnout (5 years) for private ED and private hospitalist. The gig is the same. The more patients you see, the more money you make

Hmm, I was under the impression that hospitalist gigs were more sustainable than EM... 7 on 7 off, normal working hours (though often on holidays and weekends). Could you elaborate? Also, how often do IM docs pursue fellowship training after leaving hospitalist jobs?

 

[Brigade4Radiant]

I'm struggling with this as well.

 

[icaruswalks]

Its all about the bullshit What can you stand least? If you go into private hospitalist gigs (7on 7 off) you do little more than what the ED does; get them out. Your goal is discharge. Your goal is to see as many patients as possible, only the time frame changes. If you don't mind drunks, minor lacs, psych patients and frequent fliers, to ED. You'll continually THINK you've diagnosed the problem, but since your differential is only 10 things that will kill you, you'll often be wrong. if you don't mind rocks, social work, and "coordinating care" (tracking down consultants, calling nursing homes, and face time with ancillary staff), to IM. You will actually diagnose the problem, THINK you've done good, only to see them fail anyway. Im in IM. The reason i like IM is for the problem solving, the initial differential, the diagnosis. I like the ED screens the crap for me. If its busy, I still might get handed a bad consult, but at least the other 90% has been screened away for me. I also happen to be at a place where the ED is pretty poor, leaving me to decide most of the workup inpatient. Both have tremendous burnout (5 years) for private ED and private hospitalist. The gig is the same. The more patients you see, the more money you make, and keep those patients off your service so that when you come back on shift they aren;t still there. If you were comparing primary care and ED, that's ******ed, and you clearly didn't ask that.

Haha thanks... I definitely was not asking about primary care and ED. Yeah, I like IM for the same reasons, the thinking, the differential all that. I think I'm coming to the realization that every specialty has their own level of bull****, and also that all specialties **** on each other. Like all the time.

But yeah, I see pros and cons of both. EM/IM is definitely an option, and I think I will apply to combined program, but because there are so few of them, I definitely need a backup, so the question is EM as my primary or IM... that's the struggle. Gah. Glad to know other's are in my same position as well.

As for drunks, I had a good # of pts withdrawing/put on CIWA on my medicine subI interestingly enough... haha

 

[K31]

There is also the option of doing IM and specializing in critical care. Many of the procedures would overlap and you would certainly have the acuity (and sometimes the pace). The downside would be no peds/OB.

You can also do EM then a (IM) fellowship in critical care. You can practice in the ED, and then work some in the ICU to get more of the longer-term care and in-depth workup that is lacking in the ED.

For me, I came into medical school thinking IM, but changed my mind partway through. The only reason I was considering IM was to do a critical care fellowship, and EM becoming eligible for CCM board certification took away that reason. Plus I realized that if I decided against doing a fellowship that I'd be happy practicing EM for a career--not so with general IM.

I will be applying to some EM/IM programs (specifically the few 6-year EM/IM/CCM programs) but EM is definitely primary (same as most EM/IM applicants it seems).

 

[icaruswalks]

You can also do EM then a (IM) fellowship in critical care. You can practice in the ED, and then work some in the ICU to get more of the longer-term care and in-depth workup that is lacking in the ED.

For me, I came into medical school thinking IM, but changed my mind partway through. The only reason I was considering IM was to do a critical care fellowship, and EM becoming eligible for CCM board certification took away that reason. Plus I realized that if I decided against doing a fellowship that I'd be happy practicing EM for a career--not so with general IM.

I will be applying to some EM/IM programs (specifically the few 6-year EM/IM/CCM programs) but EM is definitely primary (same as most EM/IM applicants it seems).

Yeah, definitely... though I guess for me, I liked general internal medicine too. It's a shame there aren't more EM/IM programs. 🙁

 

[MedicalStudent9]

Yeah, definitely... though I guess for me, I liked general internal medicine too. It's a shame there aren't more EM/IM programs. 🙁

How many are there, james BROlin?

 

[inspirationmd]

How many are there, james BROlin?

11....UCLA has not taken anyone in 4 years and since they changed to a 4 year EM residency I don't think that will change, you can call them to confirm that.

University of Illinois - Chicago
Henry Ford
Maryland
Long Island Jewish
ECU
VCU
Christiana Care
LSU
SUNY - Downstate
Hennepin
Allegheny

 

[235009]

As for drunks, I had a good # of pts withdrawing/put on CIWA on my medicine subI interestingly enough... haha

there's a big difference between a hospitalized patient with a legitimate medical illness who just happens to be an alcoholic vs. a drunk alcoholic brought by police for the 4th night in a row because they just dont want to deal with him

 

[icaruswalks]

Where I rotated, there were admissions just for EtOH withdrawal... so just CIWA and watching. Though I think what makes something a "legitimate medical illness" is more of a value call than anything else. The ED-Tox attendings are some of the smartest docs I've worked with so far

 

[duckie99]

I would go with IM. Your reasons are the same as mine. Great general training and then soooo many options to specialize if you want to do more procedures.

true but if that is your thought process be aware that IM subspecialities have limited number of procedures they perform. Cards = cath. GI = scopes. etc. EM really isn't set up that way and you may end up doing something different everyday.

OP pick the field you like the pace of the best. If the ER fits your personality and you like working there then pick it. A majority of what you do in EM is basic medicine stuff IM will treat anyways. As you know general IM has pretty much no procedures. To me it sounds like you enjoy the pace and procedural aspect of EM.

 

[Zatanelov]

You can also do EM then a (IM) fellowship in critical care. You can practice in the ED, and then work some in the ICU to get more of the longer-term care and in-depth workup that is lacking in the ED.

For me, I came into medical school thinking IM, but changed my mind partway through. The only reason I was considering IM was to do a critical care fellowship, and EM becoming eligible for CCM board certification took away that reason. Plus I realized that if I decided against doing a fellowship that I'd be happy practicing EM for a career--not so with general IM.

I will be applying to some EM/IM programs (specifically the few 6-year EM/IM/CCM programs) but EM is definitely primary (same as most EM/IM applicants it seems).

What did you end up matching in? I am thinking of doing EM/IM as well. Any advice? Is it something worth pursuing. I was thinking I could practice as a hospitalist and EM doc.

 

[solitarius]

This is pretty easy.

EM and IM attract two very different types of personalities.

 

[K31]

What did you end up matching in? I am thinking of doing EM/IM as well. Any advice? Is it something worth pursuing. I was thinking I could practice as a hospitalist and EM doc.

When I made my first post in this thread, I hadn't done a Medicine sub-I; after I did I completely changed my mind. I ended up just applying to EM programs and I'm very happy with that choice.

I still play with the idea of applying to critical care fellowships from time to time but I'm not planning on doing that right after residency.

 

[Instatewaiter]

true but if that is your thought process be aware that IM subspecialities have limited number of procedures they perform. Cards = cath. GI = scopes. etc. EM really isn't set up that way and you may end up doing something different everyday.

OP pick the field you like the pace of the best. If the ER fits your personality and you like working there then pick it. A majority of what you do in EM is basic medicine stuff IM will treat anyways. As you know general IM has pretty much no procedures. To me it sounds like you enjoy the pace and procedural aspect of EM.

This is a bit simplistic. Realize that Cards and GI do just more than cath and scopes. For instance, with cards the procedures you do are Balloon pumps, temp wires, permanent pacemakers, percutaneous aortic valves, percutaneous mitral valves, cardiac caths, peripheral interventions, pericardiocenteses, BAVs, BMVs, ecmo... Not to menttion dialysis lines, central lines, the occasional paracentesis or thoracentesis...

Realize that if you want to be a proceduralist, the ER is not the place to go to. There are many specialties where you will do vastly more procedures- many of them surgical, many of them not.

 

[Instatewaiter]

Also realize that general IM can be painful.

1) Placement issues
2) You are the dumping ground for other specialties
3) Just like most specialties, you see the same diagnoses over and over.
4) Social issues with the patients
5) There are many chronic issues you never cure but put off for a little bit of time- lots of frequent fliers
6) Lots of non-compliance.
7) Few procedures (could be a pro for some)
8) Hospitalists have a reasonably high burn out rate and it feels like you are a continual resident
9) Less respect than your more specialized breatheren

Realize EM can be painful
1) You are truly the main dumping ground for every clinic
2) Psych issues/drunks/addicts/pain seekers
3) No respect from other specialties
4) Competing interests with patient care (ie wait times, quick dispo)
5) Jack of all trades, master of none- see 3
6) Few procedures (more than IM, also could be a pro for some)
7) Very high burn out rate
8) You only stabilize and rarely get the final diagnosis
9) No long term relationship with patients (i guess except those frequent fliers like the drunks and pain seekers)